非agenarians主动脉瓣狭窄患者外科手术与经导管主动脉瓣置换术的比较结果。 注：这里“Nonagenarians”指的是九十多岁的人，可根据实际语境调整表述，比如“九十多岁的老年患者” 。
Comparative Outcomes of Surgical and Transcatheter Aortic Valve Replacement for Aortic Stenosis in Nonagenarians.
作者信息
Zack Chad J, Al-Qahtani Fahad, Kawsara Akram, Al-Hijji Mohammed, Amin Ali Hama, Alkhouli Mohamad
机构信息
Department of Cardiovascular Disease, Mayo Clinic, Rochester, Minnesota.
Division of Cardiovascular Disease, Department of Medicine, West Virginia University, Morgantown, West Virginia.
出版信息
Am J Cardiol. 2017 Mar 15;119(6):893-899. doi: 10.1016/j.amjcard.2016.11.045. Epub 2016 Dec 18.
Transcatheter aortic valve replacement (TAVR) emerged as a promising alternative to surgical aortic valve replacement (SAVR) in extreme-aged patients with severe aortic stenosis (AS). Data on the outcomes of TAVR or SAVR in nonagenarians are limited. The Nationwide Inpatient Sample was used to identify patients aged 90 years or older who underwent TAVR or SAVR from 2004 to 2013. In-hospital morbidity and mortality were assessed. From 2004 to 2013, 9,066 (national estimate) nonagenarians underwent aortic valve replacement. After the introduction of TAVR, most nonagenarians were treated with TAVR (76%) compared with SAVR (24%). A total of 1,847 nonagenarians who underwent SAVR (n = 1,152) or TAVR (n = 695) were included in the analysis. In-hospital mortality was similar between patients who underwent SAVR (6.4%) compared with TAVR (6.5%; p = 0.29). Vascular complications were more common after TAVR (11.9% vs 6.3%, p <0.001), whereas blood transfusion (46.2% vs 33.7%, p <0.001), and acute kidney injury (25.8% vs 20.4%, p = 0.009) were more common after SAVR. Pacemaker implantation and stroke rates were similar between the 2 groups. In a propensity-matched analysis of 630 patients who underwent isolated TAVR (n = 315) or SAVR (n = 315), in-hospital mortality was similar for (6.0% for SAVR vs 7.9% for TAVR, p = 0.35). SAVR was associated with higher rates of acute kidney injury (24.1% vs 16.8%, p = 0.02) and blood transfusion (46.0% vs 35.2%, p = 0.001), whereas TAVR was associated with increased rates of vascular complications (10.2% vs 6.0%, p = 0.07). Stroke (4.1% vs 4.1%, p = 0.99) and pacemaker implantation rates were also similar (13.0% vs 9.2%, p = 0.12) between the TAVR and SAVR groups, respectively. In conclusion, in nonagenarians, both SAVR and TAVR can be performed with acceptable in-hospital outcomes. Referral for aortic valve replacement in these patients should not be precluded based on age alone.
经导管主动脉瓣置换术（TAVR）已成为高龄重度主动脉瓣狭窄（AS）患者外科主动脉瓣置换术（SAVR）的一种有前景的替代方案。关于非agenarians行TAVR或SAVR的结局数据有限。利用全国住院患者样本确定了2004年至2013年期间接受TAVR或SAVR的90岁及以上患者。评估了住院期间的发病率和死亡率。2004年至2013年，9066例（全国估计数）非agenarians接受了主动脉瓣置换术。TAVR引入后，大多数非agenarians接受了TAVR治疗（76%），而接受SAVR治疗的为24%。共有1847例接受SAVR（n = 1152）或TAVR（n = 695）的非agenarians纳入分析。接受SAVR的患者住院死亡率（6.4%）与接受TAVR的患者（6.5%；p = 0.29）相似。TAVR后血管并发症更常见（11.9%对6.3%，p <0.001），而SAVR后输血（46.2%对33.7%，p <0.001）和急性肾损伤（25.8%对20.4%，p = 0.009）更常见。两组的起搏器植入率和卒中发生率相似。在对630例接受单纯TAVR（n = 315）或SAVR（n = 315）的患者进行的倾向匹配分析中，住院死亡率相似（SAVR为6.0%，TAVR为7.9%，p = 0.35）。SAVR与更高的急性肾损伤发生率（24.1%对16.8%，p = 0.02）和输血率（46.0%对35.2%，p = 0.001）相关，而TAVR与血管并发症发生率增加相关（10.2%对6.0%，p = 0.07）。TAVR组和SAVR组的卒中发生率（4.1%对4.1%，p = 0.99）和起搏器植入率也相似（13.0%对9.2%，p = 0.12）。总之，在非agenarians中，SAVR和TAVR均可取得可接受的住院结局。不应仅基于年龄而排除这些患者进行主动脉瓣置换术的转诊。
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