经导管瓣膜治疗的年度结果：来自 STS/ACC TVT 注册研究。

Annual Outcomes With Transcatheter Valve Therapy: From the STS/ACC TVT Registry.

机构信息

Mayo Clinic, Rochester, Minnesota.

出版信息

J Am Coll Cardiol. 2015 Dec 29;66(25):2813-2823. doi: 10.1016/j.jacc.2015.10.021. Epub 2015 Nov 30.

DOI:10.1016/j.jacc.2015.10.021

PMID:26652232

Abstract

BACKGROUND

The Society of Thoracic Surgeons (STS)/American College of Cardiology (ACC) Transcatheter Valve Therapy (TVT) Registry has been a joint initiative of the STS and the ACC in concert with multiple stakeholders. The TVT Registry has important information regarding patient selection, delivery of care, science, education, and research in the field of structural valvular heart disease.

OBJECTIVES

This report provides an overview on current U.S. TVT practice and trends. The emphasis is on demographics, in-hospital procedural characteristics, and outcomes of patients having transcatheter aortic valve replacement (TAVR) performed at 348 U.S. centers.

METHODS

The TVT Registry captured 26,414 TAVR procedures as of December 31, 2014. Temporal trends between 2012 and 2013 versus 2014 were compared.

RESULTS

Comparison of the 2 time periods reveals that TAVR patients remain elderly (mean age 82 years), with multiple comorbidities, reflected by a high mean STS predicted risk of mortality (STS PROM) for surgical valve replacement (8.34%), were highly symptomatic (New York Heart Association functional class III/IV in 82.5%), frail (slow 5-m walk test in 81.6%), and have poor self-reported health status (median baseline Kansas City Cardiomyopathy Questionnaire score of 39.1). Procedure performance is changing, with an increased use of moderate sedation (from 1.6% to 5.1%) and increase in femoral access using percutaneous techniques (66.8% in 2014). Vascular complication rates are decreasing (from 5.6% to 4.2%), whereas site-reported stroke rates remain stable at 2.2%.

CONCLUSIONS

The TVT Registry provides important information on characteristics and outcomes of TAVR in contemporary U.S. clinical practice. It can be used to identify trends in practice and opportunities for quality improvement.

摘要

背景

胸外科医师学会（STS）/美国心脏病学会（ACC）经导管瓣膜治疗（TVT）注册中心是 STS 和 ACC 与多个利益相关者共同发起的联合倡议。TVT 注册中心拥有有关结构性心脏瓣膜疾病领域的患者选择、护理提供、科学、教育和研究的重要信息。

目的

本报告概述了当前美国 TVT 的实践和趋势。重点是 348 个美国中心进行的经导管主动脉瓣置换术（TAVR）的患者人口统计学、院内手术特征和结局。

方法

截至 2014 年 12 月 31 日，TVT 注册中心共收录了 26414 例 TAVR 手术。比较了 2012 年至 2013 年与 2014 年期间的时间趋势。

结果

对这两个时间段的比较表明，TAVR 患者仍然年龄较大（平均年龄 82 岁），合并多种合并症，这反映出高风险的 STS 预测死亡率（STS PROM）用于外科瓣膜置换（8.34%），症状严重（82.5%为纽约心脏协会功能 III/IV 级），身体虚弱（81.6%的人 5 米步行测试缓慢），自我报告的健康状况较差（基线中位数堪萨斯城心肌病问卷评分 39.1）。手术操作正在发生变化，中度镇静的使用增加（从 1.6%增加到 5.1%），经皮技术的股动脉入路增加（2014 年为 66.8%）。血管并发症的发生率正在下降（从 5.6%降至 4.2%），而报告的中风发生率仍保持稳定在 2.2%。