Ahad Samir, Wachter Kristina, Rustenbach Christian, Stan Alina, Hill Stephan, Schäufele Tim, Ursulescu Adrian, Franke Ulrich F W, Baumbach Hardy
Department of Cardiovascular Surgery, Robert Bosch Hospital, Stuttgart, Germany.
Department of Cardiology, Robert Bosch Hospital, Stuttgart, Germany.
Interact Cardiovasc Thorac Surg. 2017 Jul 1;25(1):12-17. doi: 10.1093/icvts/ivx029.
Significant coronary artery disease (CAD) is common among patients evaluated for transcatheter aortic valve implantation (TAVI). Only little data exist on outcome of patients undergoing concomitant off-pump coronary revascularization and TAVI. The goal of this study was to analyse the impact of concomitant off-pump revascularization on early clinical outcome and 2-year follow-up of patients undergoing TAVI.
A total of 70 patients with significant CAD and aortic valve stenosis were included between January 2011 and January 2016. Decision to perform concomitant off-pump coronary revascularization and TAVI was made by the interdisciplinary heart team according to the SYNTAX score. Prospectively assigned data were analysed retrospectively and follow-up was performed up to 2 years.
Mean age was 82.2 ± 4.0 years and 43 (61.4%) patients were male. Mean logistic European system for cardiac operative risk evaluation and Society of Thoracic Surgeons European system for cardiac operative risk evaluation score were 35.9 ± 21.9% and 12.2 ± 7.9%, respectively. SYNTAX score was 29.0 ± 12.9. Access site for TAVI was transapical in 60.0% and transaortic in 40.0%. Procedural success was 94.3%. Eighty percent of the patients had none or trace paravalvular leakage after TAVI. Severe complications requiring consecutive surgical aortic valve replacement occurred in 2 patients (2.9%). The use of cardiopulmonary bypass due to haemodynamic instability or conversion to surgical aortic valve replacement was necessary in 7 patients (10.0%). Stroke occurred in 1 patient (1.4%). Re-exploration for bleeding was necessary in 6 patients (8.6%). Thirty-day mortality was 14.3%. Two-year survival was 68.4% (95% confidence interval: 55.7-81.1%).
Simultaneously performed complete off-pump coronary revascularization is a feasible and valid option in patients with significant CAD undergoing TAVI.
在接受经导管主动脉瓣植入术（TAVI）评估的患者中，严重冠状动脉疾病（CAD）很常见。关于同期接受非体外循环冠状动脉血运重建术和TAVI的患者的预后数据很少。本研究的目的是分析同期非体外循环血运重建术对接受TAVI患者早期临床结局和2年随访的影响。
2011年1月至2016年1月期间共纳入70例患有严重CAD和主动脉瓣狭窄的患者。跨学科心脏团队根据SYNTAX评分决定是否同期进行非体外循环冠状动脉血运重建术和TAVI。对前瞻性收集的数据进行回顾性分析，并进行长达2年的随访。
平均年龄为82.2±4.0岁，43例（61.4%）患者为男性。平均逻辑欧洲心脏手术风险评估系统和胸外科医师协会欧洲心脏手术风险评估系统评分分别为35.9±21.9%和12.2±7.9%。SYNTAX评分为29.0±12.9。TAVI的入路部位60.0%为经心尖，40.0%为经主动脉。手术成功率为94.3%。80%的患者在TAVI后无或仅有微量瓣周漏。2例患者（2.9%）发生严重并发症，需要连续进行外科主动脉瓣置换术。7例患者（10.0%）因血流动力学不稳定或转为外科主动脉瓣置换术而需要使用体外循环。1例患者（1.4%）发生卒中。6例患者（8.6%）需要再次手术止血。30天死亡率为14.3%。2年生存率为68.4%（95%置信区间：55.7 - 81.1%）。
对于接受TAVI的严重CAD患者，同期进行完全非体外循环冠状动脉血运重建术是一种可行且有效的选择。
