Hirji Sameer A, Cote Claudia, Lee Jiyae, Kiehm Spencer, McGurk Siobhan, Pelletier Marc P, Aranki Sary, Shekar Prem, Shah Pinak, Kaneko Tsuyoshi
Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
Division of Cardiac Surgery, Halifax Infirmary, Dalhousie University, Halifax, Nova Scotia, Canada.
J Card Surg. 2020 Mar;35(3):571-579. doi: 10.1111/jocs.14421. Epub 2020 Jan 25.
Patients with underlying interstitial lung disease (ILD) who undergo cardiac surgery are at high risk of postoperative pulmonary complications. It remains unclear if transcatheter aortic valve replacement (TAVR) offers any benefit over surgical aortic valve replacement (SAVR) in ILD patients with severe aortic stenosis.
All adult patients with a diagnosis of ILD who underwent either a TAVR or isolated SAVR between January 2002 and December 2017 were retrospectively reviewed. Operative mortality, 30-day readmissions, and adjusted 1-year survival were compared between the two cohorts.
The overall cohort included 52 TAVR and 74 SAVR patients. While TAVR patients were significantly older (77.2 vs 72.9 years) with higher Society of Thoracic Surgeons predicted risk of mortality (STS-PROM) scores compared with SAVR patients (6.29 vs 4.49; all P < .02), operative mortality was similar (5.8% vs 4.1%; P = .45). Rates of postoperative stroke, permanent pacemaker implantation, reintubation, and 30-day readmissions did not differ between the two groups (all P > .46). However, TAVR was associated with significantly shorter hospital and intensive care unit (ICU) length of stay, shorter ventilation times, and less requirement for ICU admission (all P < .05). Thirty-day readmissions and adjusted 1-year survival were also similar between the two groups (hazard ratio for TAVR vs SAVR = 1.34; 95% CI: 0.7-2.6).
Among ILD patients with symptomatic aortic stenosis, TAVR was associated with comparable operative and risk-adjusted 1-year survival to SAVR. TAVR patients also had shorter ventilator times, ICU and hospital stay despite being at higher risk. Together, our findings suggest that TAVR may be a better option in this unique cohort.
患有潜在间质性肺疾病（ILD）的患者接受心脏手术时，术后肺部并发症的风险很高。对于患有严重主动脉瓣狭窄的ILD患者，经导管主动脉瓣置换术（TAVR）相对于外科主动脉瓣置换术（SAVR）是否具有任何益处仍不清楚。
对2002年1月至2017年12月期间接受TAVR或单纯SAVR的所有诊断为ILD的成年患者进行回顾性分析。比较两组患者的手术死亡率、30天再入院率和调整后的1年生存率。
整个队列包括52例TAVR患者和74例SAVR患者。与SAVR患者相比，TAVR患者年龄显著更大（77.2岁对72.9岁），胸外科医师协会预测的死亡风险（STS-PROM）评分更高（6.29对4.49；所有P＜0.02），但手术死亡率相似（5.8%对4.1%；P = 0.45）。两组术后中风、永久性起搏器植入、再次插管和30天再入院率无差异（所有P＞0.46）。然而，TAVR与显著更短的住院时间和重症监护病房（ICU）住院时间、更短的通气时间以及更少的ICU入院需求相关（所有P＜0.05）。两组的30天再入院率和调整后的1年生存率也相似（TAVR与SAVR的风险比=1.34；95%CI：0.7 - 2.6）。
在有症状的主动脉瓣狭窄的ILD患者中，TAVR与SAVR的手术和风险调整后的1年生存率相当。尽管TAVR患者风险更高，但他们的呼吸机使用时间、ICU和住院时间更短。总之，我们的研究结果表明，TAVR可能是这一特殊队列的更好选择。
