Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio.
Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio.
J Am Coll Cardiol. 2018 Nov 13;72(20):2415-2426. doi: 10.1016/j.jacc.2018.08.2172.
Transfemoral-transcatheter aortic valve replacement (TF-TAVR) is increasingly used to treat aortic stenosis, but risk of post-procedure stroke is uncertain.
The purpose of this study was to assess stroke risk and its association with quality of life after surgical aortic valve replacement (SAVR) versus TF-TAVR.
The authors performed a propensity-matched study of 1,204 pairs of patients with severe aortic stenosis treated with SAVR versus TF-TAVR in the PARTNER (Placement of AoRTic TraNscathetER Valves) trials from April 2007 to October 2014. Outcomes were: 1) 30-day neurological events; 2) time-varying risk of neurological events early (≤7 days) and late (7 days to 48 months) post-procedure; and 3) association between stroke and quality of life 1 year post-procedure by the Kansas City Cardiomyopathy Questionnaire (KCCQ) overall summary score.
Thirty-day stroke (5.1% vs. 3.7%; p = 0.09) was similar, but 30-day major stroke (3.9% vs. 2.2%; p = 0.018) was lower after TF-TAVR than SAVR. In both groups, risk of stroke peaked in the first post-procedure day, followed by a near-constant low-level risk to 48 months. Major stroke was associated with a decline in quality of life at 1 year in both SAVR (KCCQ score median [15th, 85th percentile]: 79 [53, 94] without major stroke vs. 64 [30, 94] with major stroke; p = 0.03) and TF-TAVR (78 [49, 96] without major stroke vs. 60 [8, 99] with major stroke; p = 0.04).
Despite similar early-peaking (<1 day post-procedure) neurological risk profiles, SAVR is associated with a higher risk of early major stroke than TF-TAVR. Periprocedural strategies are needed to reduce stroke risk after aortic valve procedures. (Placement of AoRTic TraNscathetER Valve Trial [PARTNER]; NCT00530894).
经股动脉入路经导管主动脉瓣置换术（TF-TAVR）越来越多地用于治疗主动脉瓣狭窄，但术后中风的风险尚不确定。
本研究旨在评估主动脉瓣置换术（SAVR）与 TF-TAVR 后中风风险及其与生活质量的关系。
作者对 2007 年 4 月至 2014 年 10 月 PARTNER 试验中接受 SAVR 与 TF-TAVR 治疗的 1204 对严重主动脉瓣狭窄患者进行了倾向评分匹配研究。结局包括：1）30 天内的神经事件；2）术后早期（≤7 天）和晚期（7 天至 48 个月）神经事件的时间变化风险；3）1 年后中风与生活质量的关系（通过堪萨斯城心肌病问卷（KCCQ）总综合评分评估）。
30 天内中风发生率（5.1% vs. 3.7%；p=0.09）相似，但 TF-TAVR 术后 30 天内大中风发生率（3.9% vs. 2.2%；p=0.018）较低。在两组中，中风风险在术后第一天达到峰值，随后在 48 个月内接近持续低水平。SAVR 组中，大中风与 1 年后生活质量下降相关（KCCQ 评分中位数[15%，85%分位数]：无大中风者为 79[53，94]，有大中风者为 64[30，94]；p=0.03），TF-TAVR 组中，无大中风者为 78[49，96]，有大中风者为 60[8，99]；p=0.04）。
尽管早期（术后<1 天）神经风险特征相似，但 SAVR 与 TF-TAVR 相比，早期大中风的风险更高。需要在主动脉瓣手术后采取策略降低中风风险。（主动脉瓣经导管置换术试验[PARTNER]；NCT00530894）。
