Santarpino Giuseppe, Vogt Ferdinand, Pfeiffer Steffen, Dell'Aquila Angelo M, Jessl Jürgen, Cuomo Federica, von Wardenburg Che, Fischlein Theodor, Pauschinger Matthias, Schwab Johannes
Department of Cardiac Surgery, Paracelsus Medical University, Nuremberg, Germany. Electronic correspondence:
Department of Cardiac Surgery, Paracelsus Medical University, Nuremberg, Germany.
J Heart Valve Dis. 2017 May;26(3):255-261.
Transcatheter aortic valve implantation (TAVI), especially via the transfemoral (TF) route, is increasingly performed in patients considered in the 'gray zone' between TAVI and surgery. However, the best treatment option in this patient population remains to be established.
Since 2010, a total of 923 patients underwent either TAVI (n = 538) or sutureless aortic valve replacement (AVR) (n = 385) at the authors' institutions. Among these patients, 79 treated with TF-TAVI were compared with 79 propensity score-matched patients who had undergone elective isolated AVR with the sutureless Perceval bioprosthesis.
In-hospital mortality did not differ significantly between patients who underwent sutureless AVR or TF-TAVI (none versus three; 3.8%; p = 0.123). Similarly, postoperative complications were comparable between groups. Atrioventricular block requiring postoperative pacemaker implantation occurred in seven patients (9.2%) of the sutureless group and in eight patients (11.1%) of the TF-TAVI group (p = 0.455). The use of blood products varied between groups in terms of red blood cell transfusions (1.7 ± 2 versus 0.3 ± 0.9 units for the sutureless group versus TF-TAVI group; p <0.001). Paravalvular leakage at discharge was present in three patients (3.8%) in the sutureless group and in 26 patients (32.9%) in the TF-TAVI group (p <0.001). The mean follow up was longer for sutureless AVR (36 ± 21 versus 27 ± 20 months; p = 0.003). Survival rates were 97.5% and 84.8% in the sutureless and TF-TAVI groups, respectively (p = 0.001).
Both, TF-TAVI and sutureless AVR are well-standardized, safe and effective procedures. TF-TAVI seems to be a valuable alternative to surgical AVR for frail patients, reducing the need for perioperative blood transfusion. In contrast, in patients with a favorable long-term survival outcome, minimally invasive AVR remains the procedure of choice as it is associated with better long-term results.
经导管主动脉瓣植入术（TAVI），尤其是经股动脉（TF）途径的TAVI，在那些介于TAVI和外科手术之间的“灰色地带”患者中应用越来越多。然而，这一患者群体的最佳治疗方案仍有待确定。
自2010年以来，共有923例患者在作者所在机构接受了TAVI（n = 538）或无缝合主动脉瓣置换术（AVR）（n = 385）。在这些患者中，将79例行TF-TAVI治疗的患者与79例倾向评分匹配的、接受了使用无缝合Perceval生物瓣膜的择期孤立性AVR的患者进行比较。
接受无缝合AVR或TF-TAVI的患者住院死亡率无显著差异（分别为0例与3例；3.8%；p = 0.123）。同样，两组术后并发症相当。无缝合组有7例患者（9.2%）和TF-TAVI组有8例患者（11.1%）发生需要术后植入起搏器的房室传导阻滞（p = 0.455）。两组在血液制品使用方面，红细胞输注存在差异（无缝合组为1.7±2单位，TF-TAVI组为0.3±0.9单位；p <0.001）。出院时无缝合组有3例患者（3.8%）存在瓣周漏，TF-TAVI组有26例患者（32.9%）存在瓣周漏（p <0.001）。无缝合AVR的平均随访时间更长（36±21个月对27±20个月；p = 0.003）。无缝合组和TF-TAVI组的生存率分别为97.5%和84.8%（p = 0.001）。
TF-TAVI和无缝合AVR都是标准化程度高、安全有效的手术。对于体弱患者，TF-TAVI似乎是外科AVR的一种有价值的替代方法，可减少围手术期输血需求。相比之下，对于长期生存预后良好的患者，微创AVR仍是首选手术，因为它与更好的长期结果相关。
