Xiong Tian-Yuan, Liao Yan-Biao, Zhao Zhen-Gang, Xu Yuan-Ning, Wei Xin, Zuo Zhi-Liang, Li Yi-Jian, Cao Jia-Yu, Tang Hong, Jilaihawi Hasan, Feng Yuan, Chen Mao
Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China (T.Y.X., Y.B.L., Z.G.Z., Y.N.X., X.W., Z.L.Z., Y.J.L., J.Y.C., H.T., Y.F., M.C.).
Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (H.J.).
J Am Heart Assoc. 2015 Sep 21;4(9):e002096. doi: 10.1161/JAHA.115.002096.
Transcatheter aortic valve replacement (TAVR) is an effective alternative to surgical aortic valve replacement in patients at high surgical risk. However, there is little published literature on the exact causes of death.
The PubMed database was systematically searched for studies reporting causes of death within and after 30 days following TAVR. Twenty-eight studies out of 3934 results retrieved were identified. In the overall analysis, 46.4% and 51.6% of deaths were related to noncardiovascular causes within and after the first 30 days, respectively. Within 30 days of TAVR, infection/sepsis (18.5%), heart failure (14.7%), and multiorgan failure (13.2%) were the top 3 causes of death. Beyond 30 days, infection/sepsis (14.3%), heart failure (14.1%), and sudden death (10.8%) were the most common causes. All possible subgroup analyses were made. No significant differences were seen for proportions of cardiovascular deaths except the comparison between moderate (mean STS score 4 to 8) and high (mean STS score >8) -risk patients after 30 days post-TAVR (56.0% versus 33.5%, P=0.005).
Cardiovascular and noncardiovascular causes of death are evenly balanced both in the perioperative period and at long-term follow-up after TAVR. Infection/sepsis and heart failure were the most frequent noncardiovascular and cardiovascular causes of death. This study highlights important areas of clinical focus that could further improve outcomes after TAVR.
经导管主动脉瓣置换术（TAVR）是手术主动脉瓣置换术在外科手术风险高的患者中的一种有效替代方法。然而，关于确切死亡原因的已发表文献很少。
系统检索PubMed数据库中报告TAVR术后30天内及之后死亡原因的研究。从检索到的3934项结果中确定了28项研究。在总体分析中，分别有46.4%和51.6%的死亡与30天内及30天后的非心血管原因相关。在TAVR术后30天内，感染/脓毒症（18.5%）、心力衰竭（14.7%）和多器官功能衰竭（13.2%）是前三大死亡原因。30天后，感染/脓毒症（14.3%）、心力衰竭（14.1%）和猝死（10.8%）是最常见的原因。进行了所有可能的亚组分析。除了TAVR术后30天中度（平均STS评分4至8）和高度（平均STS评分>8）风险患者之间的比较（56.0%对33.5%，P=0.005）外，心血管死亡比例未见显著差异。
在TAVR的围手术期和长期随访中（患者）心血管和非心血管死亡原因分布均衡。感染/脓毒症和心力衰竭是最常见的非心血管和心血管死亡原因。本研究突出了临床重点关注的重要领域，这可能会进一步改善TAVR后的治疗效果。
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