经心尖与经股动脉经导管主动脉瓣植入治疗主动脉瓣狭窄和瓷化主动脉的中期结果及经股动脉与经心尖入路的系统评价

Mid-Term Outcomes after Transapical and Transfemoral Transcatheter Aortic Valve Implantation for Aortic Stenosis and Porcelain Aorta with a Systematic Review of Transfemoral versus Transapical Approach.

作者信息

Useini Dritan, Haldenwang Peter, Schlömicher Markus, Christ Hildegard, Naraghi Hamid, Moustafine Vadim, Strauch Justus

机构信息

Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bochum, Germany.

Institute of Medical Statistics, Informatics and Epidemiology, University of Cologne, Cologne, Germany.

出版信息

Thorac Cardiovasc Surg. 2020 Oct;68(7):623-632. doi: 10.1055/s-0039-1692719. Epub 2019 Jun 26.

DOI:10.1055/s-0039-1692719

PMID:31242522

Abstract

BACKGROUND

We have aimed to analyze early and mid-term outcomes of patients undergoing transapical/transfemoral transcatheter aortic valve implantation (TA-/TF-TAVI) for aortic stenosis and porcelain aorta (PAo) in our institution. Additionally, we postulated that the TA approach may be associated with a more favorable neurological outcome than the TF approach; hence, a systematic literature review was conducted.

METHODS

Between 2011 and 2017, 15 patients with PAo underwent TA-TAVI and 4 patients with PAo TF-TAVI at our institution. The assessment of PAo was done either intraoperatively after aborted sternotomy or via computed tomography for elective TAVI. We conducted mid-term follow-up. Furthermore, a systematic review was performed to compare the mortality and neurological outcomes of TF and TA-TAVI approaches.

RESULTS

TA/TF-TAVIs were performed with 100% device success, without paravalvular leakage ≥ 2 and without procedural death. The 30-day mortality/stroke rates were 6.6%/0% in TA-TAVI and 0%/25% in TF-TAVI, respectively. The 6-month, 1-year, and 2-year survival rates were in TA/TF-TAVI 93%/75%, 82%/66.6%, and 50%/0%, respectively.The pooled results derived from the literature review were as follows: The prevalence of PAo in the TAVI population is 9.74%; the mean logistic EuroSCORE is 41.9% in TA-TAVI versus 16.2% in TF-TAVI; the mean 30-day mortality is 5.9% in TA-TAVI versus 6.3% in TF-TAVI, and the mean stroke is 0.8% in TA-TAVI versus 9% in TF-TAVI.

CONCLUSION

TA-TAVI shows promising early and mid-term outcomes in patients with PAo. TF-TAVI performed in patients with PAo is likely to be associated with higher rates of stroke than TA-TAVI.

摘要

背景

我们旨在分析在我们机构中接受经心尖/经股动脉经导管主动脉瓣植入术（TA-/TF-TAVI）治疗主动脉瓣狭窄和瓷化主动脉（PAo）患者的早期和中期结果。此外，我们推测经心尖途径可能比经股途径具有更有利的神经学结果；因此，我们进行了一项系统的文献综述。

方法

2011年至2017年期间，我们机构中有15例PAo患者接受了TA-TAVI，4例PAo患者接受了TF-TAVI。PAo的评估在开胸手术失败后术中进行，或通过计算机断层扫描进行择期TAVI。我们进行了中期随访。此外，进行了一项系统综述，以比较TF和TA-TAVI途径的死亡率和神经学结果。

结果

TA/TF-TAVI手术的器械成功率为100%，无≥2级瓣周漏，无手术死亡。TA-TAVI的30天死亡率/卒中率分别为6.6%/0%，TF-TAVI为0%/25%。TA/TF-TAVI的6个月、1年和2年生存率分别为93%/75%、82%/66.6%和50%/0%。文献综述得出的汇总结果如下：TAVI人群中PAo的患病率为9.74%；TA-TAVI的平均逻辑欧洲心脏手术风险评估系统（EuroSCORE）为41.9%，而TF-TAVI为16.2%；TA-TAVI的平均30天死亡率为5.9%，TF-TAVI为6.3%，TA-TAVI的平均卒中率为0.8%，TF-TAVI为9%。