Cardounel Arturo, Gleason Thomas G, Lee Joon S, Schindler John T, Kliner Dustin, Navid Forozan, Bianco Valentino, Sultan Ibrahim
Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA, USA.
Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
Interact Cardiovasc Thorac Surg. 2018 Oct 1;27(4):494-497. doi: 10.1093/icvts/ivy114.
Despite the established efficacy of transcatheter aortic valve replacement for aortic valve replacement, vascular complications remain a major cause of procedural morbidity and mortality. In this study, we evaluate the use of femoral artery cut down with conscious sedation and report outcomes and complications associated with this approach.
Our study included 282 patients undergoing transcatheter aortic valve replacement with conscious sedation and surgical cut down for femoral access between 2015 and 2017. Data were prospectively recorded in the local institutional database and were retrospectively accessed. Descriptive statistics are presented, and a Kaplan-Meier time-to-event plot was used to estimate 1-year survival.
The mean age of the patients was 82.7 ± 7.31 years and consisted of 146 (52%) women. Echocardiographic data demonstrated a severe aortic stenosis with a mean area of 0.65 ± 0.16 cm2 and a mean gradient of 48.9 ± 13.3 mmHg. STS-PROM for the cohort was 7.2%, representing an intermediate risk group. Six (2.2%) patients died within 30 days after transcatheter aortic valve replacement. Major vascular complications occurred in 2 (0.7%) patients and minor vascular complications occurred in 6 (2.2%) patients in our cohort. Wound complications were observed in 2 (0.7%) patients.
We demonstrate that the use of conscious sedation and surgical cut down for femoral arterial access resulted in a major vascular complication rate of less than 1% and low in-hospital mortality rates without any significant increase in wound complications.
尽管经导管主动脉瓣置换术治疗主动脉瓣置换已证实有效，但血管并发症仍是手术发病率和死亡率的主要原因。在本研究中，我们评估了清醒镇静下股动脉切开术的应用，并报告了与该方法相关的结果和并发症。
我们的研究纳入了2015年至2017年间282例行经导管主动脉瓣置换术且在清醒镇静下进行外科切开以建立股动脉通路的患者。数据前瞻性记录于本地机构数据库，并进行回顾性分析。给出描述性统计数据，并使用Kaplan-Meier事件发生时间图来估计1年生存率。
患者的平均年龄为82.7±7.31岁，其中女性146例（52%）。超声心动图数据显示严重主动脉瓣狭窄，平均瓣口面积为0.65±0.16 cm²，平均跨瓣压差为48.9±13.3 mmHg。该队列的胸外科医师协会预测死亡率（STS-PROM）为7.2%，属于中度风险组。6例（2.2%）患者在经导管主动脉瓣置换术后30天内死亡。我们队列中有2例（0.7%）患者发生了主要血管并发症，6例（2.2%）患者发生了次要血管并发症。观察到2例（0.7%）患者出现伤口并发症。
我们证明，在清醒镇静下进行外科切开以建立股动脉通路，主要血管并发症发生率低于1%，住院死亡率低，且伤口并发症无显著增加。
