Erasmus Medical Center, Rotterdam, the Netherlands.
Hôpital Rangueil, Toulouse, France.
Ann Thorac Surg. 2014 Jan;97(1):22-8. doi: 10.1016/j.athoracsur.2013.09.088. Epub 2013 Nov 19.
BACKGROUND: There are no direct comparisons between transapical aortic valve implantation (TA-AVI) and transfemoral aortic valve implantation (TF-AVI). Therefore, the aim of this study was to compare the short-term and midterm outcomes of TA-AVI versus TF-AVI. METHODS: Data from four European centers were pooled and analyzed. To minimize differences between TA-AVI and TF-AVI multivariable analysis was used. Study endpoints were defined according to the Valve Academic Research Consortium-I criteria at 30 days and 1 year. Primary endpoints of this study were 30-day all-cause mortality and mortality during follow-up. RESULTS: A total of 882 patients underwent TAVI, of whom 793 (89.9%) underwent TF-AVI and 89 (10.1%) underwent TA-AVI. Patients undergoing TA-AVI had a higher estimated risk of mortality as defined by the logistic European System for Cardiac Operative Risk Evaluation score (median 27.0, interquartile range [IQR]: 20.2 to 33.8 versus median 20.0, IQR: 12.3 to 27.7; p < 0.001) and The Society of Thoracic Surgeons Score (median 10.2, IQR: 5.3 to 9.9 versus median 6.7, IQR: 3.5 to 9.9; p < 0.001) and had more comorbidities. At 30 days, there was an increased risk of all-cause mortality in the TA-AVI group (odds ratio [OR] 3.12, 95% confidence interval [CI]: 1.43 to 6.82; p = 0.004). TF-AVI was associated with a higher frequency of major (OR 0.33, 95% CI: 0.12 to 0.90; p = 0.031) and minor vascular complications (OR 0.17, 95% CI: 0.04 to 0.71; p = 0.0015). In-hospital stay was significantly longer among patients undergoing TA-AVI (OR 2.29, 95% CI: 1.28 to 4.09; p = 0.05). During a median follow-up of 365 days (IQR: 174 to 557), TA-AVI was associated with an increased risk of all-cause mortality (hazard ratio 1.88, 95% CI: 1.23 to 2.87; p = 0.004). CONCLUSIONS: In institutions performing a low volume of TA-AVI, the technique is associated with an increased risk of all-cause mortality and longer hospital stay but less vascular complications in comparison with TF-AVI. The interaction between experience and type of treatment on outcome requires further investigation before advocating one treatment over the other.
背景：经导管主动脉瓣置换术（TA-AVI）与经股动脉主动脉瓣置换术（TF-AVI）之间没有直接比较。因此，本研究旨在比较 TA-AVI 与 TF-AVI 的短期和中期结果。
方法：汇总了来自四个欧洲中心的数据并进行了分析。为了尽量减少 TA-AVI 和 TF-AVI 之间的差异，使用了多变量分析。根据瓣膜学术研究联盟-I 标准，在 30 天和 1 年时定义了研究终点。本研究的主要终点是 30 天内全因死亡率和随访期间的死亡率。
结果：共有 882 例患者接受了 TAVI，其中 793 例（89.9%）接受了 TF-AVI，89 例（10.1%）接受了 TA-AVI。接受 TA-AVI 的患者的死亡率预计风险更高，根据逻辑欧洲心脏手术风险评估系统评分（中位数 27.0，四分位距 [IQR]：20.2 至 33.8 与中位数 20.0，IQR：12.3 至 27.7；p <0.001）和胸外科医师协会评分（中位数 10.2，IQR：5.3 至 9.9 与中位数 6.7，IQR：3.5 至 9.9；p <0.001）和更多的合并症。在 30 天时，TA-AVI 组的全因死亡率风险增加（优势比 [OR] 3.12，95%置信区间 [CI]：1.43 至 6.82；p = 0.004）。TF-AVI 与更高的主要（OR 0.33，95%CI：0.12 至 0.90；p = 0.031）和次要血管并发症（OR 0.17，95%CI：0.04 至 0.71；p = 0.0015）的发生率相关。接受 TA-AVI 的患者的住院时间明显更长（OR 2.29，95%CI：1.28 至 4.09；p = 0.05）。在中位数为 365 天（IQR：174 至 557）的中位随访期间，TA-AVI 与全因死亡率增加相关（风险比 1.88，95%CI：1.23 至 2.87；p = 0.004）。
结论：在进行 TA-AVI 低容量的机构中，与 TF-AVI 相比，该技术与全因死亡率增加和住院时间延长相关，但血管并发症较少。经验与治疗类型之间对结果的相互作用需要进一步研究，然后才能提倡一种治疗方法优于另一种治疗方法。
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