高危患者经导管主动脉瓣置换术与外科主动脉瓣置换术的倾向评分匹配分析。
Transcatheter versus Surgical Aortic Valve Replacement in High-risk Patients: A propensity-score matched analysis.
作者信息
Zweng India, Shi William Y, Palmer Sonny, MacIsaac Andrew, Whitbourn Robert, Davis Philip, Newcomb Andrew E
机构信息
St Vincent's Hospital, Melbourne, Vic, Australia; University of Melbourne, Melbourne, Vic, Australia.
St Vincent's Hospital, Melbourne, Vic, Australia; University of Melbourne, Melbourne, Vic, Australia.
出版信息
Heart Lung Circ. 2016 Jul;25(7):661-7. doi: 10.1016/j.hlc.2016.01.005. Epub 2016 Feb 11.
BACKGROUND
There is limited data from Australia and New Zealand comparing transcatheter aortic valve implantation (TAVI) with conventional surgical aortic valve replacement (sAVR).
METHODS
Between 2009 and 2015, 64 patients underwent TAVI and 669 underwent sAVR at a single centre. Patients' peri-operative details were analysed and compared between groups. Propensity-score matching was performed for risk adjustment.
RESULTS
Patients receiving TAVI were older (mean age in years TAVI: 83.9±4.6 vs. sAVR: 71±9.9, P<0.001), and were more likely to be female (TAVI: 67%, 43/64, vs. sAVR: 32%, 217/669, P <0.001). Unadjusted 30-day mortality was comparable between groups (2/64, 3% vs. 22/669, 3%, P >0.99). The matched analysis revealed comparable 30-day mortality (TAVI: 2/44, 5% vs. sAVR: 2/44, 5%, P > 0.99). New atrial arrhythmia occurred more frequently within the sAVR cohort (TAVI: 1/44, 2% vs. sAVR 18/44, 41%, P <0.001). Complete heart block requiring permanent pacemaker was more frequent amongst the TAVI cohort (TAVI: 10/44, 23% vs. sAVR 2/44, 5%, P=0.039). At two years, survival was comparable between groups (TAVI: 74±1.7 vs. sAVR: 80±0.1%, P=0.65).
CONCLUSION
This single centre experience suggests that TAVI is a valuable treatment option for high-risk surgical patients with comparable survival.
背景
来自澳大利亚和新西兰的比较经导管主动脉瓣植入术（TAVI）与传统外科主动脉瓣置换术（sAVR）的数据有限。
方法
2009年至2015年间，在单一中心，64例患者接受了TAVI，669例接受了sAVR。分析并比较了两组患者的围手术期详细情况。进行倾向得分匹配以进行风险调整。
结果
接受TAVI的患者年龄更大（TAVI组平均年龄：83.9±4.6岁，sAVR组：71±9.9岁，P<0.001），且更可能为女性（TAVI组：67%，43/64，sAVR组：32%，217/669，P<0.001）。未调整的30天死亡率在两组之间相当（2/64，3%对22/669，3%，P>0.99）。匹配分析显示30天死亡率相当（TAVI组：2/44，5%，sAVR组：2/44，5%，P>0.99）。新发房性心律失常在sAVR队列中更频繁出现（TAVI组：1/44，2%，sAVR组：18/44，41%，P<0.001）。需要永久起搏器的完全性心脏传导阻滞在TAVI队列中更常见（TAVI组：10/44，23%，sAVR组：2/44，5%，P=0.039）。在两年时，两组的生存率相当（TAVI组：74±1.7，sAVR组：80±0.1%，P=0.65）。
结论
这一单一中心的经验表明，对于高危外科手术患者，TAVI是一种有价值的治疗选择，其生存率相当。
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