Shehada Sharaf-Eldin, Elhmidi Yacine, Puluca Nazan, Öztürk Öznur, Demircioglu Ender, Wendt Daniel, Jakob Heinz, Thielmann Matthias
Department of Thoracic and Cardiovascular Surgery, West-German Heart Center Essen, University Duisburg-Essen, Essen, Germany -
Department of Cardiovascular Surgery, German Heart Center Munich, Munich, Germany.
J Cardiovasc Surg (Torino). 2017 Oct;58(5):787-793. doi: 10.23736/S0021-9509.17.09636-7. Epub 2017 Apr 4.
Redo surgical aortic valve replacement after prior cardiac surgery is usually related to a higher risk of mortality and morbidity. Transcatheter aortic valve implantation (TAVI) became an alternative therapy for those patients in the past couple of years.
We aimed in this study to analyze the outcomes of patients undergoing TAVI after a prior cardiac surgery especially those who underwent coronary artery bypass grafting (CABG) and to see if TAVI offers any advantages for those patients than conventional surgical aortic valve replacement.
We searched for relevant articles in Medline and abstracted clinical information based on pre-defined criteria and endpoints. Data of nine studies including the baseline characteristics, implantation data, postoperative outcomes and major adverse cardiac complications, which were published between 2011 and 2015 were collected and evaluated. From all reviewed studies, 769 patients had a prior cardiac surgery and underwent TAVI for symptomatic severe aortic stenosis. Of these, 738 patients (96%) had prior CABG. Patients' age ranged from 78±3 to 82±5.8 years. The STS and EuroSCORE ranged from 4.5±3% to 14.7±12.3% and 25.6±16.2% to 37±18%, respectively. In all reviewed studies the 30-day mortality was about 5.6% and was not significantly higher compared to patients with no history of prior cardiac surgery. The total incidence of stroke was about 3.6%, myocardial infarction was 1.7%, acute kidney injury was 13.8% and permanent pacemaker implantation was about 14.2%.
However, patients presented with severe aortic valve disease after a previous cardiac surgery exhibited a higher preoperative STS and EuroSCORE than those without previous cardiac surgery. The 30-day mortality was not significantly higher in comparison to those patients without history of prior cardiac surgery. According to that, transcatheter aortic valve implantation should be considered as an attractive alternative for those patients.
在先前心脏手术后再次进行外科主动脉瓣置换术通常与更高的死亡和发病风险相关。在过去几年中，经导管主动脉瓣植入术（TAVI）成为了这些患者的一种替代治疗方法。
我们在本研究中的目的是分析先前心脏手术后接受TAVI的患者的结局，尤其是那些接受冠状动脉旁路移植术（CABG）的患者，并观察TAVI相对于传统外科主动脉瓣置换术是否为这些患者带来任何优势。
我们在Medline中搜索了相关文章，并根据预先定义的标准和终点提取了临床信息。收集并评估了2011年至2015年间发表的9项研究的数据，包括基线特征、植入数据、术后结局和主要不良心脏并发症。在所有纳入综述的研究中，769例患者先前接受过心脏手术并因有症状的严重主动脉瓣狭窄接受了TAVI。其中，738例患者（96%）先前接受过CABG。患者年龄在78±3至82±5.8岁之间。胸外科医师协会（STS）评分和欧洲心脏手术风险评估系统（EuroSCORE）评分分别在4.5±3%至14.7±12.3%和25.6±16.2%至37±18%之间。在所有纳入综述的研究中，30天死亡率约为5.6%，与无先前心脏手术史的患者相比无显著升高。卒中总发生率约为3.6%，心肌梗死为1.7%，急性肾损伤为13.8%，永久起搏器植入率约为14.2%。
然而，先前心脏手术后出现严重主动脉瓣疾病的患者术前STS评分和EuroSCORE评分高于无先前心脏手术史的患者。与无先前心脏手术史的患者相比，30天死亡率无显著升高。据此，经导管主动脉瓣植入术应被视为这些患者的一种有吸引力的替代方案。
