Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas2Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas.
Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas3Department of Cardiology, Baylor College of Medicine, Houston, Texas.
JAMA Surg. 2013 Dec;148(12):1087-93. doi: 10.1001/jamasurg.2013.3743.
The US Food and Drug Administration recently approved the use of a transcatheter aortic valve in patients for whom traditional valve replacement surgery poses a high or prohibitive risk. Our hospital was one of the first Veterans Affairs facilities to launch a transcatheter aortic valve replacement (TAVR) program.
To evaluate our early experience with transfemoral TAVR.
We retrospectively reviewed the records of all patients who underwent TAVR during the first year of our program at the Department of Cardiothoracic Surgery, Michael E. DeBakey Veterans Affairs Medical Center.
The mean (SD) age of the patients was 77 (9) years, and their mean (SD) Society of Thoracic Surgeons predicted risk of mortality score was 8.8 (10.7).
All patients underwent TAVR with the SAPIEN transcutaneous valve.
We evaluated operative mortality and major operative morbidity (stroke, myocardial infarction, renal failure necessitating dialysis, and requirement for mechanical circulatory support, as well as vascular complications and requirement for permanent pacemaker), in addition to length of hospital stay and discharge status.
Between December 21, 2011, and December 13, 2012, a total of 19 transfemoral TAVR procedures were performed at our center. Implantation was successful in all cases. There were no reports of operative (30-day) mortality, prosthetic valve endocarditis, renal failure necessitating dialysis, perioperative myocardial infarction or stroke, or conversion to surgical aortic valve replacement. Seven patients (37%) had mild paravalvular leak, 3 patients (16%) had moderate paravalvular leak, 2 patients (11%) had groin wound complications, 2 patients (11%) required a permanent pacemaker, 1 patient (5%) had a vascular access complication requiring endovascular repair, and 1 patient (5%) required temporary circulatory support (with extracorporeal membrane oxygenation). The mean (SD) length of hospital stay after TAVR was 8.0 (5.9) days. All patients were discharged home.
Transcatheter aortic valve replacement can be performed safely and with good outcomes at a Veterans Affairs facility with a committed multidisciplinary team and substantial experience in heart valve and endovascular therapies.
美国食品和药物管理局最近批准在传统瓣膜置换手术风险较高或禁忌的患者中使用经导管主动脉瓣。我们医院是首批开展经导管主动脉瓣置换术（TAVR）项目的退伍军人事务部设施之一。
评估我们在经股 TAVR 方面的早期经验。
我们回顾性地审查了在迈克尔·E·德贝基退伍军人事务医疗中心心胸外科部门开展该项目的第一年期间接受 TAVR 的所有患者的记录。
患者的平均（标准差）年龄为 77（9）岁，平均（标准差）胸外科医师协会预测死亡率评分 8.8（10.7）。
所有患者均接受 SAPIEN 经皮瓣膜 TAVR。
我们评估了手术死亡率和主要手术并发症（中风、心肌梗死、需要透析的肾衰竭、需要机械循环支持，以及血管并发症和需要永久性起搏器），以及住院时间和出院情况。
2011 年 12 月 21 日至 2012 年 12 月 13 日，我们中心共进行了 19 例经股 TAVR 手术。所有病例均成功植入。无手术（30 天）死亡率、人工瓣膜心内膜炎、需要透析的肾衰竭、围手术期心肌梗死或中风、或转为外科主动脉瓣置换的报告。7 例（37%）患者有轻度瓣周漏，3 例（16%）患者有中度瓣周漏，2 例（11%）患者有腹股沟伤口并发症，2 例（11%）患者需要永久性起搏器，1 例（5%）患者血管入路并发症需要血管内修复，1 例（5%）患者需要临时循环支持（体外膜肺氧合）。TAVR 后平均（标准差）住院时间为 8.0（5.9）天。所有患者均出院回家。
退伍军人事务部设施中有一个致力于多学科团队的设施，并在心脏瓣膜和血管内治疗方面拥有丰富的经验，经导管主动脉瓣置换术可以安全进行，且结果良好。
