Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia; and Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia.
Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia; and Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia.
JACC Cardiovasc Interv. 2017 Mar 13;10(5):500-507. doi: 10.1016/j.jcin.2016.11.043.
The aim of this study was to compare outcomes of transcatheter intervention (TI) versus surgical intervention (SI) for paravalvular leak (PVL).
Data comparing the treatment of PVL with TI and SI are limited.
A retrospective cohort study was conducted comparing baseline characteristics, procedural details, and 1-year survival in consecutive patients who underwent TI or SI for moderate or greater PVL from 2007 to 2016. The primary outcome was a composite of death, reintervention for PVL, or readmission for congestive heart failure-related symptoms at 1 year.
Of 114 patients, 56 underwent TI and 58 underwent SI. PVL locations were mitral, aortic, and pulmonary in 69 (60.5%), 39 (34.2%), and 6 (5.3%) patients, respectively. At baseline, TI patients were older (age 71 vs. 62 years; p = 0.010) and had fewer cases of active endocarditis (0.0% vs. 25.9%, p < 0.001) than SI patients. The TI group had a shorter post-operative stay (4 vs. 8 days; p < 0.001), a shorter intensive care unit stay (0 vs. 3 days; p < 0.001), and fewer readmissions at 30 days (8.9% vs. 25.9%; p = 0.017). There were no differences in the primary endpoint (TI 33.9% vs. SI 39.7%; p = 0.526) or 1-year survival (TI 83.9% vs. SI 75.9%; p = 0.283) between groups.
In this study, TI for PVL closure had comparable 1-year clinical outcomes with SI, even after adjusting for differences in baseline characteristics, with less in-hospital morbidity and 30-day rehospitalization. Although further study is needed, these findings support the increased implementation of TI for PVL closure at experienced institutions.
本研究旨在比较经导管介入（TI）与手术干预（SI）治疗瓣周漏（PVL）的结局。
比较 TI 与 SI 治疗 PVL 的数据有限。
本回顾性队列研究比较了 2007 年至 2016 年间连续接受 TI 或 SI 治疗中重度或以上 PVL 的患者的基线特征、操作细节和 1 年生存率。主要结局是 1 年时死亡、PVL 再干预或充血性心力衰竭相关症状再入院的复合结局。
114 例患者中，56 例行 TI，58 例行 SI。PVL 部位分别为二尖瓣、主动脉瓣和肺动脉瓣，分别占 69 例（60.5%）、39 例（34.2%）和 6 例（5.3%）。基线时，TI 组患者年龄较大（71 岁 vs. 62 岁；p = 0.010），且较少有活动性心内膜炎（0.0% vs. 25.9%；p < 0.001）。TI 组的术后住院时间较短（4 天 vs. 8 天；p < 0.001），重症监护病房住院时间较短（0 天 vs. 3 天；p < 0.001），30 天内再入院率较低（8.9% vs. 25.9%；p = 0.017）。两组主要终点（TI 组 33.9% vs. SI 组 39.7%；p = 0.526）或 1 年生存率（TI 组 83.9% vs. SI 组 75.9%；p = 0.283）均无差异。
在这项研究中，经导管介入治疗 PVL 闭合的 1 年临床结局与手术治疗相当，即使在调整了基线特征差异后，其院内发病率和 30 天再住院率也较低。尽管还需要进一步研究，但这些发现支持在有经验的机构中增加经导管介入治疗 PVL 闭合的应用。
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