Daniec Marzena, Sorysz Danuta, Dziewierz Artur, Kleczyński Paweł, Rzeszutko Łukasz, Krawczyk-Ożóg Agata, Dudek Dariusz
Second Department of Cardiology, Jagiellonian University Medical College, Krakow, Poland.
Department of Interventional Cardiology, Jagiellonian University Medical College, Krakow, Poland.
J Interv Cardiol. 2018 Feb;31(1):60-67. doi: 10.1111/joic.12418. Epub 2017 Aug 22.
Severe aortic stenosis (AS) often coexists with significant coronary artery disease.
To evaluate procedural complications and long-term outcomes of patients with severe AS undergoing balloon aortic valvuloplasty (BAV) and percutaneous coronary intervention (PCI).
A total of 97 patients with severe AS underwent 104 BAVs as palliative procedure, bridge to definitive treatment, or before urgent non-cardiac surgery. Patients were followed-up for at least 12 months.
Of the 97 patients, 34 (35.0%) underwent standalone BAV, 45 (46.4%) underwent BAV with coronary angiography, and 18 (18.6%) BAV with PCI. There were no differences in baseline characteristics and indications for BAV among the groups (P > 0.05). No higher risk of complications after BAV performed with concomitant coronary angiography/PCI was observed. Transcatheter aortic valve implantation was performed after BAV in 13 (13.4%) patients and surgical aortic valve replacement in three (3.1%) patients. In spite of no difference in in-hospital mortality (5.6% vs. 8.9%; P = 0.76), patients with BAV and concomitant PCI had lower long-term mortality than patients with BAV and concomitant coronary angiography (28.5% vs. 51.0%; P = 0.03). In multivariable Cox analysis adjusted for age, sex, and body mass index, the Society of Thoracic Surgeons Predicted Risk of Mortality score was identified as the only independent predictor of long-term mortality for all patients (HR: 1.09, 95%CI: 1.04-1.15, P = 0.0006).
Concomitant PCI or coronary angiography performed with BAV may not increase the risk of major and vascular complications. Patients with BAV and concomitant PCI may have better survival than patients with BAV and concomitant coronary angiography.
严重主动脉瓣狭窄（AS）常与显著的冠状动脉疾病并存。
评估接受球囊主动脉瓣成形术（BAV）和经皮冠状动脉介入治疗（PCI）的严重AS患者的手术并发症和长期预后。
共有97例严重AS患者接受了104次BAV，作为姑息治疗、确定性治疗的桥梁或在紧急非心脏手术前进行。对患者进行了至少12个月的随访。
97例患者中，34例（35.0%）接受单纯BAV，45例（46.4%）接受BAV联合冠状动脉造影，18例（18.6%）接受BAV联合PCI。各组间BAV的基线特征和适应证无差异（P>0.05）。未观察到BAV联合冠状动脉造影/PCI后并发症风险更高。13例（13.4%）患者在BAV后接受了经导管主动脉瓣植入术，3例（3.1%）患者接受了外科主动脉瓣置换术。尽管住院死亡率无差异（5.6%对8.9%；P=0.76），但BAV联合PCI患者的长期死亡率低于BAV联合冠状动脉造影患者（28.5%对51.0%；P=0.03）。在对年龄、性别和体重指数进行调整的多变量Cox分析中，胸外科医师协会预测的死亡风险评分被确定为所有患者长期死亡率的唯一独立预测因素（HR：1.09，95%CI：1.04-1.15，P=0.0006）。
BAV联合PCI或冠状动脉造影可能不会增加主要和血管并发症的风险。BAV联合PCI患者的生存率可能优于BAV联合冠状动脉造影患者。
