Eggebrecht Holger, Mehta Rajendra H, Haude Michael, Sack Stefan, Mudra Harald, Hein Ralph, Brachmann Johannes, Gerckens Ulrich, Kuck Karl-Heinz, Zahn Ralf, Sechtem Udo, Richardt Gert, Schneider Steffen, Senges Jochen
Cardioangiologisches Centrum Bethanien (CCB) and AGAPLESION Bethanien Hospital, Frankfurt, Germany.
EuroIntervention. 2014 Sep;10(5):602-8. doi: 10.4244/EIJV10I5A105.
To analyse patient characteristics, decision-making processes, and outcomes of TAVI performed in hospitals with versus those without on-site cardiac surgery (CS).
Current guidelines mandate transcatheter aortic valve implantation (TAVI) to be performed at hospitals with both cardiology and on-site CS departments. Some hospitals in Germany perform TAVI without CS departments in-house. We analysed the data of 1,432 patients enrolled in the German TAVI registry at 27 hospitals between January 2009 and June 2010. Nineteen of these had on-site CS (group 1), while eight centres performed TAVI with no CS department at their institution (group 2). Patients in group 2 (n=178, 12% of the overall study population) were older than in group 1 (mean age 82.6±6.3 years vs. 81.6±6.2 years) with similar logistic EuroSCORE (average: 21%). Patients in group 2 were haemodynamically more stable (higher blood pressures, better ejection fraction, less low-flow or low-gradient aortic stenosis, and less urgent procedures). Procedure times and use of contrast were higher in group 2. The procedural success rate was higher in group 1 (98% vs. 95%). Post-procedural complications were similar in the two groups with 30-day mortality of 6.2% in group 2 compared with 8.3% in group 1 patients.
Only 12% of patients enrolled in the German TAVI registry underwent TAVI at hospitals without an on-site CS department. Overall patient characteristics appeared to be similar, although patients in non-CS centres appeared to be haemodynamically more stable and more often had a history of previous heart surgery. Despite longer procedures, complication rates were similar. These preliminary data in a modest number of patients suggest the feasibility of performing TAVI in appropriately selected patients at hospitals without CS but this requires confirmation in future studies involving a large number of patients.
分析在有与没有现场心脏外科手术（CS）的医院中进行经导管主动脉瓣植入术（TAVI）的患者特征、决策过程及结果。
当前指南要求经导管主动脉瓣植入术在同时设有心脏病学和现场心脏外科科室的医院进行。德国一些医院在没有内部心脏外科科室的情况下开展TAVI。我们分析了2009年1月至2010年6月期间在27家医院登记参加德国TAVI注册研究的1432例患者的数据。其中19家医院有现场心脏外科手术（第1组），而8个中心在其机构没有心脏外科科室的情况下进行TAVI（第2组）。第2组患者（n = 178，占总体研究人群的12%）比第1组患者年龄更大（平均年龄82.6±6.3岁对81.6±6.2岁），逻辑欧洲心脏手术风险评估系统（EuroSCORE）相似（平均：21%）。第2组患者血流动力学更稳定（血压更高、射血分数更好、低流量或低梯度主动脉瓣狭窄更少、急诊手术更少）。第2组的手术时间和造影剂使用量更高。第1组的手术成功率更高（98%对95%）。两组术后并发症相似，第2组患者30天死亡率为6.2%，第1组患者为8.3%。
在德国TAVI注册研究中，只有12%的患者在没有现场心脏外科科室的医院接受TAVI。总体患者特征似乎相似，尽管非心脏外科中心的患者血流动力学似乎更稳定，且更常有既往心脏手术史。尽管手术时间更长，但并发症发生率相似。这些少量患者的初步数据表明，在没有心脏外科手术的医院对适当选择的患者进行TAVI是可行的，但这需要在未来涉及大量患者的研究中得到证实。
