贫血患者经导管主动脉瓣植入术与外科主动脉瓣置换术的比较
Transcatheter aortic valve implantation compared with surgical aortic valve replacement in patients with anaemia.
作者信息
D'Errigo Paola, Biancari Fausto, Rosato Stefano, Tamburino Corrado, Ranucci Marco, Santoro Gennaro, Barbanti Marco, Ventura Martina, Fusco Danilo, Seccareccia Fulvia
机构信息
a Centre for Global Health, Istituto Superiore di Sanità , Rome , Italy.
b Oulu University Hospital , Oulu , Finland.
出版信息
Acta Cardiol. 2018 Feb;73(1):50-59. doi: 10.1080/00015385.2017.1327627. Epub 2017 Aug 16.
OBJECTIVES
We compared the outcome of anaemic patients undergoing transcatheter (TAVI) and surgical aortic valve replacement (SAVR) for severe aortic valve stenosis.
METHODS
Anaemic patients (haemoglobin <13.0 g/dL in men and <12.0 g/dL in women) undergoing TAVI and SAVR from the OBSERVANT study were the subjects of this analysis.
RESULTS
Preoperative anaemia was an independent predictor of 3-year mortality after either TAVI (HR 1.37, 95% CI 1.12-1.68) and SAVR (HR 1.63, 95% CI 1.37-1.99). Propensity score matching resulted in 302 pairs with similar characteristics. Patients undergoing SAVR had similar 30-d mortality (3.6% versus 3.3%, p = .81) and stroke (1.3% versus 2.0%, p = .53) compared with TAVI. The rates of pacemaker implantation (18.6% versus 3.0%, p < .001), major vascular damage (5.7% versus 0.4%, p < .001) and mild-to-severe paravalvular regurgitation (47.4% versus 9.3%, p < .001) were higher after TAVI, whereas acute kidney injury (50.7% versus 27.9%, p < .001) and blood transfusion (70.0% versus 38.6%, p < .001) were more frequent after SAVR. At 3-year, survival was 74.0% after SAVR and 66.3% after TAVI, respectively (p = .065), and freedom from MACCE was 67.6% after SAVR and 58.7% after TAVI, respectively (p = .049).
CONCLUSIONS
These results suggest that TAVI is not superior to SAVR in patients with anaemia.
目的
我们比较了严重主动脉瓣狭窄的贫血患者接受经导管主动脉瓣植入术（TAVI）和外科主动脉瓣置换术（SAVR）的结果。
方法
本分析的对象是来自OBSERVANT研究中接受TAVI和SAVR的贫血患者（男性血红蛋白<13.0 g/dL，女性血红蛋白<12.0 g/dL）。
结果
术前贫血是TAVI（HR 1.37，95%CI 1.12 - 1.68）和SAVR（HR 1.63，95%CI 1.37 - 1.99）后3年死亡率的独立预测因素。倾向评分匹配产生了302对具有相似特征的患者。与TAVI相比，接受SAVR的患者30天死亡率（3.6%对3.3%，p = 0.81）和中风发生率（1.3%对2.0%，p = 0.53）相似。TAVI后起搏器植入率（18.6%对3.0%，p < 0.001）、主要血管损伤率（5.7%对0.4%，p < 0.001）和轻至重度瓣周反流率（47.4%对9.3%，p < 0.001）更高，而SAVR后急性肾损伤（50.7%对27.9%，p < 0.001）和输血率（70.0%对38.6%，p < 0.001）更频繁。3年时，SAVR后的生存率为74.0%，TAVI后的生存率为66.3%（p = 0.065），SAVR后无主要不良心血管和脑血管事件（MACCE）的发生率为67.6%，TAVI后为58.7%（p = 0.049）。
结论
这些结果表明，在贫血患者中，TAVI并不优于SAVR。
Zotero 插件