Higuchi Ryosuke, Tobaru Tetsuya, Hagiya Kenichi, Saji Mike, Mahara Keitaro, Takamisawa Itaru, Shimizu Jun, Takanashi Shuichiro, Takayama Morimasa
Department of Cardiology, Sakakibara Heart Institute, 3-16-1 Asahi-cho, Fuchu, Tokyo, 183-0003, Japan.
Department of Anesthesiology, Sakakibara Heart Institute, Tokyo, Japan.
Heart Vessels. 2017 Oct;32(10):1236-1243. doi: 10.1007/s00380-017-0996-1. Epub 2017 May 23.
Transcatheter aortic valve implantation (TAVI) is recommended for patients who are inoperable or at high risk for surgical aortic valve replacement (SAVR). Corticosteroid therapy is considered to be a risk factor for SAVR, but there is a paucity of information about TAVI in patients taking corticosteroids. The aim of this study is to elucidate the outcome of TAVI in patients on chronic corticosteroid therapy, compared with SAVR. We retrospectively analyzed patients on corticosteroid therapy who underwent TAVI (n = 21) or SAVR (n = 30) for severe aortic stenosis in Sakakibara Heart Institute. Primary outcome was a 30-day composite endpoint consisting of early safety endpoints (death, stroke, life-threatening bleeding, acute kidney injury, coronary obstruction, major vascular complication, and valve-related dysfunction) and corticosteroid-specific endpoints (adrenal insufficiency, sepsis, and hyperglycemic complication). There were no differences between two groups in background factors, other than patient age and serum albumin level (age 81.0 ± 5.5 vs. 74.7 ± 9.9 years, p = 0.0061, albumin 3.6 ± 0.4 vs. 4.0 ± 0.4 g/dl, p = 0.0076). Device success rate for TAVI was 95.2%. In TAVI group, operative time was shorter (100.2 ± 46.2 vs. 250.0 ± 92.2 min, p < 0.0001), and the amount of blood transfusion was less (0.67 ± 1.8 vs. 3.5 ± 2.4 units, p < 0.0001) than in SAVR group. There was no difference in primary outcome (19.0 vs. 20.0%, p = 1.0). Rate of prosthesis-patient mismatch was lower in TAVI group (4.8 vs. 33.3%, p = 0.017), and no moderate or severe post-procedural aortic regurgitation was observed in both groups. The post-procedural survival was similar in the two groups (p = 0.67, mean follow-up 986 ± 922 days). TAVI may be a viable therapeutic option in patients taking corticosteroids.
对于无法进行手术或手术主动脉瓣置换术（SAVR）风险较高的患者，推荐经导管主动脉瓣植入术（TAVI）。皮质类固醇治疗被认为是SAVR的一个风险因素，但关于服用皮质类固醇的患者接受TAVI的信息较少。本研究的目的是阐明长期接受皮质类固醇治疗的患者接受TAVI与SAVR相比的结果。我们回顾性分析了在酒匂心脏研究所因严重主动脉瓣狭窄接受TAVI（n = 21）或SAVR（n = 30）的接受皮质类固醇治疗的患者。主要结局是一个30天的综合终点，包括早期安全终点（死亡、中风、危及生命的出血、急性肾损伤、冠状动脉阻塞、主要血管并发症和瓣膜相关功能障碍）和皮质类固醇特异性终点（肾上腺功能不全、败血症和高血糖并发症）。除患者年龄和血清白蛋白水平外，两组的背景因素无差异（年龄81.0±5.5岁 vs. 74.7±9.9岁，p = 0.0061；白蛋白3.6±0.4 vs. 4.0±0.4 g/dl，p = 0.0076）。TAVI的器械成功率为95.2%。在TAVI组中，手术时间较短（100.2±46.2 vs. 250.0±92.2分钟，p < 0.0001），输血量较少（0.67±1.8 vs. 3.5±2.4单位，p < 0.0001），均低于SAVR组。主要结局无差异（19.0% vs. 20.0%，p = 1.0）。TAVI组的人工瓣膜-患者不匹配率较低（4.8% vs. 33.3%，p = 0.017），两组均未观察到中度或重度术后主动脉瓣反流。两组术后生存率相似（p = 0.67，平均随访986±922天）。TAVI可能是服用皮质类固醇患者的一种可行治疗选择。
