Cardioangiological Center Bethanien (CCB) and AGAPLESION Bethanien Hospital, Frankfurt, Germany
ProMedCon GmbH, Ebenhausen, Germany.
Eur Heart J. 2016 Jul 21;37(28):2240-8. doi: 10.1093/eurheartj/ehw190. Epub 2016 May 17.
Performing transcatheter aortic valve implantation (TAVI) at hospitals with only cardiology department but no cardiac surgery (CS) on-site is at great odds with current Guidelines.
We analysed data from the official, prospective German Quality Assurance Registry on Aortic Valve Replacement to compare characteristics and in-hospital outcomes of patients undergoing transfemoral TAVI at hospitals with (n = 75) and without CS departments (n = 22). An interdisciplinary Heart Team was established at all centres (internal staff physicians at hospitals with on-site CS; in-house cardiologists and visiting cardiac surgical teams from collaborating hospitals at non-CS hospitals). In 2013 and 2014, 17 919 patients (81.2 ± 6.1 years, 55% females, German aortic valve (GAV) score 2.0 5.6 ± 5.8%, logistic EuroSCORE I 21.1 ± 15.4%) underwent transfemoral TAVI in Germany: 1332 (7.4%) at hospitals without on-site CS department. Patients in non-CS hospitals were older (82.1 ± 5.8 vs. 81.1 ± 6.1 years, P < 0.001), with more frequent co-morbidities. Predicted mortality risks per GAV-score 2.0 (6.1 + 5.5 vs. 5.5 ± 5.9%, P < 0.001) and logEuroSCORE I (23.2 ± 15.8 vs. 21.0 ± 15.4%, P < 0.001) were higher in patients at non-CS sites. Complications, including strokes (2.6 vs. 2.3%, P = 0.452) and in-hospital mortality (3.8 vs. 4.2%, P = 0.396), were similar in both groups. Matched-pair analysis of 555 patients in each group with identical GAV-score confirmed similar rates of intraprocedural complications (9.2 vs. 10.3%, P = 0.543), strokes (3.2% for both groups, P = 1.00), and in-hospital mortality (1.8 vs. 2.9%, P = 0.234).
Although patients undergoing TAVI at hospitals without on-site CS department were older and at higher predicted perioperative death risk, major complications, and in-hospital mortality were not statistically different, suggesting the feasibility and safety of Heart Team-based TAVI at non-CS sites. These findings need confirmation in future randomized study.
在仅有心脏病科而无心脏外科的医院进行经导管主动脉瓣置换术（TAVI）与当前指南相矛盾。
我们分析了德国主动脉瓣置换术官方、前瞻性质量保证登记处的数据，以比较在有（n=75）和无（n=22）心脏外科部门的医院行经股 TAVI 的患者的特征和住院期间结局。所有中心都成立了跨学科心脏团队（有现场心脏外科的医院内部工作人员医生；非心脏外科医院的内部心脏病专家和来访的心脏外科团队）。2013 年和 2014 年，德国有 17919 例患者（81.2±6.1 岁，55%为女性，德国主动脉瓣（GAV）评分 2.05.6±5.8%，逻辑 EuroSCORE I 21.1±15.4%）接受经股 TAVI：1332 例（7.4%）在无现场心脏外科部门的医院。非心脏外科医院的患者年龄更大（82.1±5.8 岁 vs. 81.1±6.1 岁，P<0.001），合并症更频繁。按 GAV 评分 2.0 预测的死亡率（6.1+5.5 岁 vs. 5.5+5.9%，P<0.001）和 logEuroSCORE I（23.2+15.8 岁 vs. 21.0+15.4%，P<0.001）在非心脏外科部位的患者中更高。两组的并发症包括中风（2.6% vs. 2.3%，P=0.452）和住院死亡率（3.8% vs. 4.2%，P=0.396）相似。每组 555 例具有相同 GAV 评分的匹配对分析证实，术中并发症（9.2% vs. 10.3%，P=0.543）、中风（两组均为 3.2%，P=1.00）和住院死亡率（1.8% vs. 2.9%，P=0.234）相似。
尽管在无现场心脏外科部门的医院接受 TAVI 的患者年龄更大，围手术期死亡风险更高，但主要并发症和住院死亡率无统计学差异，表明心脏团队为基础的非心脏外科部位 TAVI 的可行性和安全性。这些发现需要在未来的随机研究中得到证实。
