英国经导管主动脉瓣植入术：时间趋势、结局预测因素和 6 年随访：来自英国经导管主动脉瓣植入术（TAVI）登记处的报告，2007 年至 2012 年。
Transcatheter aortic valve implantation in the United Kingdom: temporal trends, predictors of outcome, and 6-year follow-up: a report from the UK Transcatheter Aortic Valve Implantation (TAVI) Registry, 2007 to 2012.
机构信息
From Queen Elizabeth Hospital, Birmingham, UK (P.F.L.); Royal Brompton and Harefield Hospital, London, UK (N.M., A.D.); James Cook University Hospital, Middlesbrough, UK (M.A.d.B.); Leeds Teaching Hospitals, Leeds, UK (D.J.B.); Cardiovascular Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust, London, UK (W.B.); Kings College Hospital, London, UK (P.A.M., O.W.); National Institute for Cardiovascular Outcome Research, London, UK (D.C., D.M.); Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, UK (D.H.-S., U.T.); St. Thomas's Hospital, London, UK (C.P.Y.); Leicester Cardiovascular Biomedical Research Unit, University Hospital NHS Trust, Leicester, UK (J.K., T.S.); Royal Infirmary of Edinburgh, Edinburgh, UK (N.G.U.); West Midlands Public Health England Centre, Birmingham, UK (J.H.); and University Hospital Southampton, Southampton, UK (H.G.)
From Queen Elizabeth Hospital, Birmingham, UK (P.F.L.); Royal Brompton and Harefield Hospital, London, UK (N.M., A.D.); James Cook University Hospital, Middlesbrough, UK (M.A.d.B.); Leeds Teaching Hospitals, Leeds, UK (D.J.B.); Cardiovascular Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust, London, UK (W.B.); Kings College Hospital, London, UK (P.A.M., O.W.); National Institute for Cardiovascular Outcome Research, London, UK (D.C., D.M.); Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, UK (D.H.-S., U.T.); St. Thomas's Hospital, London, UK (C.P.Y.); Leicester Cardiovascular Biomedical Research Unit, University Hospital NHS Trust, Leicester, UK (J.K., T.S.); Royal Infirmary of Edinburgh, Edinburgh, UK (N.G.U.); West Midlands Public Health England Centre, Birmingham, UK (J.H.); and University Hospital Southampton, Southampton, UK (H.G.).
出版信息
Circulation. 2015 Mar 31;131(13):1181-90. doi: 10.1161/CIRCULATIONAHA.114.013947. Epub 2015 Jan 30.
BACKGROUND
We assessed trends in the performance of transcatheter aortic valve implantation in the United Kingdom from the first case in 2007 to the end of 2012. We analyzed changes in case mix, complications, outcomes to 6 years, and predictors of mortality.
METHODS AND RESULTS
Annual cohorts were examined. Mortality outcomes were analyzed in the 92% of patients from England and Wales for whom independent mortality tracking was available. A total of 3980 transcatheter aortic valve implantation procedures were performed. In successive years, there was an increase in frequency of impaired left ventricular function, but there was no change in Logistic EuroSCORE. Overall 30-day mortality was 6.3%; it was highest in the first cohort (2007-2008), after which there were no further significant changes. One-year survival was 81.7%, falling to 37.3% at 6 years. Discharge by day 5 rose from 16.7% in 2007 and 2008 to 28% in 2012. The only multivariate preprocedural predictor of 30-day mortality was Logistic EuroSCORE ≥40. During long-term follow-up, multivariate predictors of mortality were preprocedural atrial fibrillation, chronic obstructive pulmonary disease, creatinine >200 μmol/L, diabetes mellitus, and coronary artery disease. The strongest independent procedural predictor of long-term mortality was periprocedural stroke (hazard ratio=3.00; P<0.0001). Nonfemoral access and postprocedural aortic regurgitation were also significant predictors of adverse outcome.
CONCLUSIONS
We analyzed transcatheter aortic valve implantation in an entire country, with follow-up over 6 years. Although clinical profiles of enrolled patients remained unchanged, longer-term outcomes improved, and patients were discharged earlier. Periprocedural stroke, nonfemoral access, and postprocedural aortic regurgitation are predictors of adverse outcome, along with intrinsic patient risk factors.
背景
我们评估了 2007 年首例病例至 2012 年底英国经导管主动脉瓣植入术的表现趋势。我们分析了病例组合、并发症、6 年结局的变化以及死亡率的预测因素。
方法和结果
对每年的队列进行了检查。对英格兰和威尔士 92%的患者进行了独立死亡率追踪，分析了这些患者的死亡率结果。共进行了 3980 例经导管主动脉瓣植入术。在连续几年中，左心室功能受损的频率增加，但 Logistic EuroSCORE 没有变化。总的 30 天死亡率为 6.3%；第一个队列（2007-2008 年）最高，之后没有进一步显著变化。一年生存率为 81.7%，6 年时降至 37.3%。出院时间从 2007 年和 2008 年的 16.7%上升到 2012 年的 28%。30 天死亡率的唯一多变量术前预测因素是 Logistic EuroSCORE≥40。在长期随访中，死亡的多变量预测因素是术前心房颤动、慢性阻塞性肺疾病、肌酐>200μmol/L、糖尿病和冠状动脉疾病。长期死亡率的最强独立手术预测因素是围手术期卒中（风险比=3.00；P<0.0001）。非股动脉入路和术后主动脉瓣反流也是不良结局的重要预测因素。
结论
我们在一个国家内分析了经导管主动脉瓣植入术，随访时间超过 6 年。尽管纳入患者的临床特征保持不变，但长期结局有所改善，患者更早出院。围手术期卒中、非股动脉入路和术后主动脉瓣反流以及固有患者风险因素是不良结局的预测因素。
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