Baumbach Hardy, Ahad Samir, Rustenbach Christian, Hill Stephan, Schäufele Tim, Wachter Kristina, Franke Ulrich Friedrich Wilhelm
Department of Cardiovascular Surgery, Robert-Bosch-Krankenhaus, Stuttgart, Germany.
Department of Cardiology, Robert-Bosch-Krankenhaus, Stuttgart, Germany.
Thorac Cardiovasc Surg. 2017 Apr;65(3):212-217. doi: 10.1055/s-0036-1586491. Epub 2016 Aug 12.
The incidence of degenerative aortic valve diseases has increased along with the life expectancy of our population. Although conventional aortic valve replacement (AVR) is the gold standard for symptomatic aortic stenosis, transcatheter procedures have proven to be a valid therapeutic option in high-risk patients. The aim of this study was to compare these procedures in a high-risk cohort. We retrospectively analyzed all symptomatic (dyspnea or angina) high-risk patients (logistic EuroSCORE ≥ 15%) fulfilling the transcatheter aortic valve implantation (TAVI) indications. Most of the AVR patients ( = 180) were operated on before the implementation of TAVI. All TAVI procedures ( = 127) were performed transapically (TA). After matching for age, logistic EuroSCORE, and left ventricular ejection fraction, 82 pairs of patients were evaluated. When comparing AVR with TA-TAVI, there was no difference between groups in survival after 1 year (Kaplan-Meier analysis, 81.1% [95% CI: 72.5-89.7%] vs. 75.8% [95% CI: 66.2-75.9%], Log tank = 0.660) and the complication rates ( for AVR vs. TA-TAVI: stroke, 2 vs. 0, = 0.580; acute renal insufficiency, 8 vs. 12, = 0.340; atrial fibrillation, 24 vs. 26, = 0.813; pacemaker implantation, 4 vs. 4, > 0.999). In addition, quality of life did not differ between groups. Patients in the TA-TAVI group had lower mean valvular gradients postoperatively compared with the AVR group (14.6 ± 6.6 vs. 10.2 ± 4.9 mm Hg, < 0.001). For high-risk patients, the TAVI procedure is comparable with conventional AVR, but is not advantageous. These results do not support the expansion of TAVI to low- or intermediate-risk patients.
退行性主动脉瓣疾病的发病率随着我国人口预期寿命的延长而增加。尽管传统的主动脉瓣置换术（AVR）是有症状主动脉瓣狭窄的金标准，但经导管手术已被证明是高危患者的一种有效治疗选择。本研究的目的是在高危队列中比较这些手术。我们回顾性分析了所有符合经导管主动脉瓣植入术（TAVI）指征的有症状（呼吸困难或心绞痛）高危患者（逻辑欧洲心脏手术风险评估系统评分≥15%）。大多数AVR患者（n = 180）在TAVI实施之前接受了手术。所有TAVI手术（n = 127）均经心尖（TA）进行。在对年龄、逻辑欧洲心脏手术风险评估系统评分和左心室射血分数进行匹配后，对82对患者进行了评估。当比较AVR与TA-TAVI时，两组在1年生存率（Kaplan-Meier分析，81.1% [95% CI：72.5 - 89.7%] 对75.8% [95% CI：66.2 - 75.9%]，Log秩检验 = 0.660）和并发症发生率方面无差异（AVR与TA-TAVI相比：中风，2例对0例，P = 0.580；急性肾功能不全，8例对12例，P = 0.340；心房颤动，24例对26例，P = 0.813；起搏器植入，4例对4例，P > 0.999）。此外，两组的生活质量无差异。与AVR组相比，TA-TAVI组患者术后平均瓣膜压差较低（14.6 ± 6.6对10.2 ± 4.9 mmHg，P < 0.001）。对于高危患者，TAVI手术与传统AVR相当，但并无优势。这些结果不支持将TAVI扩展至低危或中危患者。
