Lancashire Cardiac Center, Blackpool Victoria Hospital, Blackpool, UK; Department of Cardiovascular Medicine, Ain Shams University, Cairo, Egypt.
Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota.
Am J Cardiol. 2020 Apr 15;125(8):1239-1248. doi: 10.1016/j.amjcard.2020.01.021. Epub 2020 Jan 28.
To compare the outcomes in trans-femoral transcatheter aortic valve implantation (TF-TAVI) performed with percutaneous approach (PC) versus surgical cut-down (SC). In 13 trials including 5,859 patients (PC = 3447, SC = 2412), the outcomes based on Valve Academic Research Consortium criteria were compared between PC and SC in TF-TAVI. Compared with SC, PC was associated with similar major vascular complications (VCs) (8.7% vs 8.5%; odds ratio [OR] = 0.93, 95% confidence interval [CI] = 0.76 to 1.15, p = 0.53), major bleeding (OR = 1.09, 95% CI = 0.66 to 1.8, p = 0.73), perioperative mortality (5.7% vs 5.2%; OR = 1.13, 95% CI = 0.85 to 1.49, p = 0.4), urgent surgical repair (OR = 1.27, 95% CI = 0.81 to 2.02, p = 0.3), stroke (3.3% vs 3.9%; OR = 0.85, 95% CI = 0.53 to 1.36, p = 0.5), myocardial infarction (1.3% vs 1.1%; OR = 1.06, 95% CI = 0.53 to 2.12, p = 0.86), and renal failure (5.2% vs 5.9%; OR = 0.68, 95% CI = 0.38 to 1.22, p = 0.2), but shorter hospital stay (9.1 ± 8.5 vs 9.6 ± 9.5 days; mean difference = -1.07 day, 95% CI = -2.0 to -0.15, p = 0.02) and less blood transfusion (18.5% vs 25.7%; OR = 0.61, 95% CI = 0.43-0.86, p = 0.005). Minor VCs occurred more frequently in PC compared to SC (11.9% vs 6.9%; OR = 1.67, 95% CI = 1.04-2.67, p = 0.03). In conclusion, in TF-TAVI, PC is a safe and feasible alternative to SC, and adopting either approach depends on operator experience after ensuring that vascular access could be safely achieved with that specific technique.
比较经皮入路（PC）与外科切开（SC）行经股动脉经导管主动脉瓣置换术（TF-TAVI）的结果。在包括 5859 名患者的 13 项试验中（PC=3447，SC=2412），比较了 PC 和 SC 在 TF-TAVI 中的基于 Valve Academic Research Consortium 标准的结果。与 SC 相比，PC 与相似的主要血管并发症（VCs）（8.7%比 8.5%；比值比[OR]为 0.93，95%置信区间[CI]为 0.76 至 1.15，p=0.53）、主要出血（OR 为 1.09，95%CI 为 0.66 至 1.8，p=0.73）、围手术期死亡率（5.7%比 5.2%；OR 为 1.13，95%CI 为 0.85 至 1.49，p=0.4）、紧急外科修复（OR 为 1.27，95%CI 为 0.81 至 2.02，p=0.3）、中风（3.3%比 3.9%；OR 为 0.85，95%CI 为 0.53 至 1.36，p=0.5）、心肌梗死（1.3%比 1.1%；OR 为 1.06，95%CI 为 0.53 至 2.12，p=0.86）和肾衰竭（5.2%比 5.9%；OR 为 0.68，95%CI 为 0.38 至 1.22，p=0.2），但住院时间更短（9.1±8.5 比 9.6±9.5 天；平均差值为-1.07 天，95%CI 为-2.0 至-0.15，p=0.02）和输血更少（18.5%比 25.7%；OR 为 0.61，95%CI 为 0.43-0.86，p=0.005）。PC 中比 SC 更频繁发生较小的 VC（11.9%比 6.9%；OR 为 1.67，95%CI 为 1.04-2.67，p=0.03）。总之，在 TF-TAVI 中，PC 是 SC 的一种安全且可行的替代方法，采用哪种方法取决于操作者的经验，并且在确保可以安全地通过特定技术获得血管通路后，再做出选择。
