O'Sullivan K E, Early S A, Casserly I, Chugtai Z, Sugrue D, Hurley J
Mater Misericordiae University Hospital, Mater Private Hospital, Eccles St, Dublin 7, Ireland,
Ir J Med Sci. 2014 Dec;183(4):653-7. doi: 10.1007/s11845-014-1071-x. Epub 2014 Feb 1.
The advent of transcatheter aortic valve implantation (TAVI) has broadened the management options for severe aortic stenosis. The indications for TAVI are narrow. Selecting those that will benefit most from this intervention warrants careful consideration and input from cardiologists, anaesthetists and cardiac surgeons familiar with TAVI and surgical aortic valve replacement (SAVR).
The aims of this paper were to assess the feasibility of establishing a high-risk aortic clinic in Ireland, and report stratification of the referred group into those suitable for SAVR, TAVI and conservative management.
Patient data was prospectively collected by a dedicated clinical nurse specialist. ANOVA was used to assess variance in means between groups. Analyses were performed using IBM SPSS v20 (Armonk, NY: IBM Corp.).
A total of 105 patients were assessed. Eighty-five patients were deemed suitable for TAVI, 9 (10.5 %) died awaiting the procedure and a further 6 (7 %) declined intervention. Eleven (10.5 %) underwent conventional SAVR, 1 (0.9 %) a balloon valvuloplasty, 4 (3.8 %) entered surveillance and 4 (3.8 %) were declined treatment.
Establishment of a high-risk aortic clinic is feasible in the Irish context. The advent of TAVI has reduced the proportion of patients denied intervention to a minority. Despite being considered high risk, a number of patients were suitable candidates for SAVR. Measuring frailty continues to provide a challenge; a TAVI-specific frailty assessment tool would be advantageous to patient stratification.
经导管主动脉瓣植入术（TAVI）的出现拓宽了重度主动脉瓣狭窄的治疗选择。TAVI的适应证较窄。选择那些能从该干预措施中获益最大的患者需要心脏病专家、麻醉师和熟悉TAVI及外科主动脉瓣置换术（SAVR）的心脏外科医生仔细考虑并提供意见。
本文旨在评估在爱尔兰建立高危主动脉疾病诊所的可行性，并报告将转诊患者分层为适合SAVR、TAVI和保守治疗的患者情况。
由一名专门的临床护士专家前瞻性收集患者数据。采用方差分析评估组间均值的差异。使用IBM SPSS v20（纽约州阿蒙克：IBM公司）进行分析。
共评估了105例患者。85例患者被认为适合TAVI，9例（10.5%）在等待手术过程中死亡，另有6例（7%）拒绝干预。11例（10.5%）接受了传统SAVR，1例（0.9%）接受了球囊瓣膜成形术，4例（3.8%）进入监测阶段，4例（3.8%）被拒绝治疗。
在爱尔兰建立高危主动脉疾病诊所是可行的。TAVI的出现已将被拒绝干预的患者比例降至少数。尽管被认为是高危患者，但仍有一些患者适合SAVR。评估虚弱程度仍然是一项挑战；一种针对TAVI的虚弱评估工具将有利于患者分层。
