Division of Cardiovascular Surgery.
Ann Cardiothorac Surg. 2012 Jul;1(2):138-44. doi: 10.3978/j.issn.2225-319X.2012.06.06.
Off-pump transapical aortic valve implantation (TA-TAVI) through mini-thoracotomy was first performed in Vancouver, Canada in October 2005. The objective of this manuscript is to describe the Vancouver experience with 178 TA-TAVI cases in symptomatic severe aortic stenosis (AS) since 2005.
Baseline characteristics and in-hospital outcomes were calculated for the overall cohort. To compare pre-procedure and post-procedure echocardiographic measurements, one way analysis of variance was utilized, followed by Tukey's HSD. In-hospital outcomes were compared between early and late cohorts using Z-test and chi-squared test as appropriate. Kaplan-Meier analysis was used to generate 3-year survival curves. The Log-rank test was used to compare survival between low-risk and high-risk groups, based on STS score.
Between October 2005-March 2012, TA-TAVI was performed in 178 patients. Mean age was 80.5±8.6 years. Congestive heart failure and renal failure were more common in the late cohort, while previous myocardial infarction was more common in the early cohort (P<0.05). Eleven patients (6.2%) had significant intra-operative complications, including death (1.7%), conversion to CPB (3.9%), and valve embolization (1.1%). In-hospital survival was 87.9%. Mean length of hospital stay was 12.2±17.1 days. In-hospital incidence of stroke was 3.4%. Bleeding (20.2% vs. 4.7%) and vascular (14.6% vs. 3.5%) complications were more common in the early cohort. Echocardiography demonstrated a significant increase in aortic valve area and decrease in mean transvalvular gradient post-procedure. These improvements were maintained throughout the 3-year follow-up period. Overall survival was 72.1% at 6 months, 67.7% at 12 months, 55.5% at 24 months, and 47.3% at 36 months. Repeated Kaplan-Meier analysis for the 2 groups stratified by STS score, demonstrated improved survival in the low-risk group (Log-rank P=0.039).
Among patients with symptomatic severe AS at high risk for conventional AVR, TA-TAVI is a reasonable therapeutic option with acceptable risk. Long-term survival appears to be superior in lower-risk patients.
无泵经心尖主动脉瓣植入术（TA-TAVI）于 2005 年 10 月在加拿大温哥华首次实施。本文的目的是描述自 2005 年以来，178 例因有症状的严重主动脉瓣狭窄（AS）而行 TA-TAVI 的温哥华经验。
计算了整个队列的基线特征和住院结局。为了比较术前和术后的超声心动图测量值，采用单因素方差分析，然后采用 Tukey 的 HSD。使用 Z 检验和适当的卡方检验比较早期和晚期队列的住院结局。使用 Kaplan-Meier 分析生成 3 年生存率曲线。根据 STS 评分，使用对数秩检验比较低危组和高危组之间的生存情况。
2005 年 10 月至 2012 年 3 月，共对 178 例患者进行了 TA-TAVI。平均年龄为 80.5±8.6 岁。充血性心力衰竭和肾功能衰竭在晚期队列中更为常见，而早期队列中则更为常见的是心肌梗死（P<0.05）。11 例（6.2%）患者术中出现严重并发症，包括死亡（1.7%）、转为体外循环（3.9%）和瓣膜栓塞（1.1%）。院内生存率为 87.9%。平均住院时间为 12.2±17.1 天。院内卒中发生率为 3.4%。早期组的出血（20.2%比 4.7%）和血管（14.6%比 3.5%）并发症更为常见。超声心动图显示术后主动脉瓣面积明显增加，平均跨瓣梯度降低。这些改善在整个 3 年随访期间得以维持。6 个月时总体生存率为 72.1%，12 个月时为 67.7%，24 个月时为 55.5%，36 个月时为 47.3%。根据 STS 评分对 2 组进行重复 Kaplan-Meier 分析，低危组的生存率提高（Log-rank P=0.039）。
对于有症状的高危常规 AVR 的严重 AS 患者，TA-TAVI 是一种合理的治疗选择，风险可接受。长期生存率在低危患者中似乎更高。
