Department of Cardiology and Angiology I, Medical Faculty, University of Freiburg, University Heart Center Freiburg, Freiburg, Germany.
Faculty of Medicine and Medical Center - University of Freiburg, Institute of Medical Biometry and Statistics, Freiburg, Germany.
Catheter Cardiovasc Interv. 2020 Mar 1;95(4):810-816. doi: 10.1002/ccd.28361. Epub 2019 Jun 4.
Transcatheter aortic valve replacement (TAVR) is routinely used in patients with severe aortic stenosis at increased operative risk. Due to potential technical difficulties, TAVR is not recommended for pure aortic regurgitation (AR). Smaller studies reported its use in AR, but data from big registries are lacking. The present study analyzes the nationwide use of surgical aortic valve replacement (SAVR) and TAVR in patients with AR from 2008 until 2015.
We identified 138,237 cases of aortic valve replacement in Germany based on ICD and OPS codes.
Of 13.2% SAVR-cases and 1.3% of TAVR cases were performed in AR. AR patients undergoing SAVR were younger with lower logistic EuroSCORE (stenosis: 6.1 ± 5.6; AR: 4.5 ± 4.9). Nevertheless, stroke rates, bleedings, prolonged mechanical ventilation, and in-hospital mortality were higher (mortality: stenosis 2.6%, AR: 4.7%). In the TAVR group, patients with AR were at higher operative risk (logistic EuroSCORE: transfemoral (TF)-TAVR: stenosis: 14.3 ± 10.4; AR: 17.3 ± 13.3. Transapical (TA)-TAVR: stenosis: 16.1 ± 11.4; AR: 15.7 ± 12.2). Stroke rates were lower, but bleedings and prolonged ventilation occurred more frequently after TF-TAVR in AR compared to stenosis. The mortality varied markedly (TF-TAVR: 15.2% in 2011; 2.8% in 2015; TA-TAVR: 17.7% in 2012 and 0% in 2014).
TAVR is off-label used in AR in clinical practice. TAVR seems to be a safe option for AR with regard to in-hospital outcomes. However, further research evaluating long-term outcomes is required to establish the feasibility of TAVR in pure AR.
经导管主动脉瓣置换术（TAVR）常用于手术风险较高的重度主动脉瓣狭窄患者。由于潜在的技术困难，TAVR 不推荐用于单纯主动脉瓣反流（AR）。一些较小的研究报告了其在 AR 中的应用，但缺乏来自大型注册研究的数据。本研究分析了 2008 年至 2015 年期间德国使用外科主动脉瓣置换术（SAVR）和 TAVR 治疗 AR 患者的情况。
我们根据国际疾病分类和操作代码确定了 138237 例主动脉瓣置换术病例。
在 SAVR 病例中，有 13.2%为 AR，TAVR 病例中有 1.3%为 AR。接受 SAVR 的 AR 患者更年轻，logistic EuroSCORE 较低（狭窄：6.1±5.6；AR：4.5±4.9）。然而，中风发生率、出血、机械通气时间延长和住院死亡率较高（死亡率：狭窄 2.6%，AR 4.7%）。在 TAVR 组中，AR 患者的手术风险较高（经股动脉（TF）-TAVR：狭窄：14.3±10.4；AR：17.3±13.3。经心尖（TA）-TAVR：狭窄：16.1±11.4；AR：15.7±12.2）。AR 患者经 TF-TAVR 治疗后的中风发生率较低，但出血和机械通气时间延长的发生率高于狭窄患者。死亡率差异显著（TF-TAVR：2011 年为 15.2%；2015 年为 2.8%；TA-TAVR：2012 年为 17.7%，2014 年为 0%）。
TAVR 在 AR 的临床实践中是一种超适应证应用。就住院期间的结果而言，TAVR 似乎是 AR 的一种安全选择。然而，需要进一步的研究来评估长期结果，以确定 TAVR 在单纯 AR 中的可行性。
