Condado Jose F, Haider Moosa N, Lerakis Stamatios, Keegan Patricia, Caughron Hope, Thourani Vinod H, Devireddy Chandan, Leshnower Bradley, Mavromatis Kreton, Sarin Eric L, Stewart James, Guyton Robert, Forcillo Jessica, Patel Ateet, Simone Amy, Block Peter C, Babaliaros Vasilis
Structural Heart and Valve Center, Divisions of Cardiology, Emory University, Atlanta, Georgia.
Department of Medicine, Emory University, Atlanta, Georgia.
Catheter Cardiovasc Interv. 2017 Mar 1;89(4):775-780. doi: 10.1002/ccd.26683. Epub 2016 Nov 12.
To compare outcomes after minimalist and standard transfemoral transcatheter aortic valve replacement (TF-TAVR) in patients with severe chronic obstructive pulmonary disease (COPD).
TF-TAVR is increasingly performed with conscious sedation and transthoracic echocardiography guidance (minimalist). The safety/efficacy of this technique in patients with severe COPD is unknown.
We compared demographics, 30-day outcomes and 1-year survival of patients with severe COPD (FEV1% ≤50) who underwent minimalist vs. standard TF-TAVR between 2008 and 2015 at our institution.
Of 88 patients with severe COPD, 46 underwent minimalist and 42 underwent standard TF-TAVR. There were no differences on baseline characteristics, except for more history of coronary artery bypass grafting (45.5% vs. 20.6%, P = 0.03) and less history of cerebrovascular disease (16.7% vs. 45.5%, P = 0.03) in the standard TF-TAVR. Seventeen minimalist TF-TAVR patients (41.0%) were transferred directly to the general medical ward with telemetry monitoring (without ICU stay); all standard TF-TAVR patients went to the ICU. Minimalist TF-TAVR patients had shorter procedure time (97 vs. 129 min, P < 0.001), ICU time (21.8 vs. 29.8 hr, P = 0.001) and length of stay (2 vs. 5 days, P = 0.001). There were no differences in procedure complications and 30-day mortality between groups. In our multivariate analysis, minimalist TF-TAVR (HR 0.28, 95%CI 0.08-0.97) and previous coronary revascularization (HR 0.24, 95%CI 0.09-0.65) were associated with increased 1-year survival. In contrast, moderate paravalvular leak (HR 7.73, 95%CI 1.94-30.84) was associated with decreased 1-year survival.
In patients with severe COPD, Minimalist TF-TAVR results in less resource utilization and improved 1-year survival compared to standard approach. Our findings should be validated in a larger cohort of patients with severe COPD. © 2016 Wiley Periodicals, Inc.
比较重度慢性阻塞性肺疾病（COPD）患者接受微创与标准经股动脉经导管主动脉瓣置换术（TF-TAVR）后的结局。
TF-TAVR越来越多地在清醒镇静和经胸超声心动图引导下进行（微创）。该技术在重度COPD患者中的安全性/有效性尚不清楚。
我们比较了2008年至2015年在我院接受微创与标准TF-TAVR的重度COPD患者（FEV1%≤50）的人口统计学、30天结局和1年生存率。
88例重度COPD患者中，46例接受了微创TF-TAVR，42例接受了标准TF-TAVR。除标准TF-TAVR组冠状动脉搭桥手术史更多（45.5%对20.6%，P = 0.03）和脑血管疾病史更少（16.7%对45.5%，P = 0.03）外，两组基线特征无差异。17例微创TF-TAVR患者（41.0%）直接转至普通内科病房进行遥测监测（未入住重症监护病房）；所有标准TF-TAVR患者均入住重症监护病房。微创TF-TAVR患者的手术时间更短（97对129分钟，P < 0.001）、重症监护病房时间更短（21.8对29.8小时，P = 0.001）和住院时间更短（2对5天，P = 0.001）。两组手术并发症和30天死亡率无差异。在我们的多变量分析中，微创TF-TAVR（风险比0.28，95%置信区间0.08 - 0.97）和既往冠状动脉血运重建（风险比0.24，95%置信区间0.09 - 0.65）与1年生存率增加相关。相反，中度瓣周漏（风险比7.73，95%置信区间1.94 - 30.84）与1年生存率降低相关。
在重度COPD患者中，与标准方法相比，微创TF-TAVR导致资源利用更少且1年生存率提高。我们的研究结果应在更大规模的重度COPD患者队列中得到验证。©2016威利期刊公司
