Department of Cardiology, Bichat-Claude-Bernard Hospital, AP-HP, 75018 Paris, France; University Paris Diderot, 75013 Paris, France.
Department of Cardiology, Bichat-Claude-Bernard Hospital, AP-HP, 75018 Paris, France.
Arch Cardiovasc Dis. 2019 Aug-Sep;112(8-9):512-522. doi: 10.1016/j.acvd.2019.05.008. Epub 2019 Aug 29.
Despite the worldwide development of transcatheter aortic valve implantation (TAVI) over the last decade, strategies that take patient characteristics into account to guide the choice of transcatheter heart valve have not been evaluated.
To evaluate the immediate results of TAVI using a tailored choice of balloon-expandable or self-expanding transcatheter heart valve, according to each patient's clinical and anatomical characteristics.
This single-centre observational study included all patients treated with TAVI from 2012 to 2017. The 30-day results were reported according to Valve Academic Research Consortium-2 criteria. A total of 502 patients were included (mean age, 81±9 years; 52% men; mean EuroSCORE II, 7.0±6.5%). Three main variables guided the choice of transcatheter heart valve: the anatomy of the iliofemoral arteries and of the aortic root, and the general condition of the patient.
A SAPIEN™ balloon-expandable transcatheter heart valve was used in 275 patients (55%) and a CoreValve™ self-expanding transcatheter heart valve in 227 patients (45%). The approach was transfemoral in 427 patients (85%), and only 29 patients (6%) required transthoracic access. At 30-day follow-up, the rates of adverse events were as follows: mortality, 3.2%; stroke, 3.0%; major bleeding, 5.9%; and major vascular complications, 6.0%. Rates of complications at 30 days were similar in the SAPIEN™ and CoreValve™ groups, except for a higher rate of pacemaker implantation in the latter group (29.5% vs. 14.5%; P<0.001).
The choice of balloon-expandable or self-expanding transcatheter heart valve tailored to the patient's clinical and anatomical characteristics allows for maximal use of the transfemoral approach, and is associated with low 30-day rates of major complications and mortality.
尽管在过去十年中，经导管主动脉瓣植入术（TAVI）在全球范围内得到了发展，但尚未评估根据患者特征制定策略来指导经导管心脏瓣膜选择的情况。
根据每位患者的临床和解剖特征，评估采用量身定制的球囊扩张型或自膨式经导管心脏瓣膜进行 TAVI 的即刻结果。
这项单中心观察性研究纳入了 2012 年至 2017 年期间接受 TAVI 治疗的所有患者。根据 Valve Academic Research Consortium-2 标准报告 30 天结果。共纳入 502 例患者（平均年龄 81±9 岁；52%为男性；平均 EuroSCORE II 为 7.0±6.5%）。有三个主要变量指导经导管心脏瓣膜的选择：髂股动脉和主动脉根部的解剖结构以及患者的一般状况。
275 例患者（55%）使用 SAPIEN™球囊扩张型经导管心脏瓣膜，227 例患者（45%）使用 CoreValve™自膨式经导管心脏瓣膜。经股入路者 427 例（85%），仅 29 例（6%）需要经胸入路。30 天随访时，不良事件发生率如下：死亡率为 3.2%；卒中为 3.0%；大出血为 5.9%；大血管并发症为 6.0%。SAPIEN™和 CoreValve™组的并发症发生率在 30 天相似，但后者的起搏器植入率较高（29.5%比 14.5%；P<0.001）。
根据患者的临床和解剖特征选择球囊扩张型或自膨式经导管心脏瓣膜，可最大限度地采用经股入路，且 30 天内主要并发症和死亡率较低。
