Maidman Samuel D, Lisko John C, Kamioka Norihiko, Chen Edward P, Mavromatis Kreton, Halkos Michael, Stewart James P, Lattouf Omar M, Keeling W Brent, Gleason Patrick, Sommerfeld Alex J, Maini Aneesha, Ibrahim Akram W, Grubb Kendra J, Leshnower Bradley G, Guyton Robert, Greenbaum Adam B, Block Peter C, Babaliaros Vasilis C, Devireddy Chandan
Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States of America.
Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, GA, United States of America.
Cardiovasc Revasc Med. 2020 Oct;21(10):1313-1318. doi: 10.1016/j.carrev.2020.03.021. Epub 2020 Mar 16.
To compare transcatheter aortic valve replacement (TAVR) with surgical aortic valve replacement (SAVR) for patients in shock.
There are minimal data on the clinical and echocardiographic outcomes for patients in shock that undergo TAVR and no data comparing these outcomes to similar patients undergoing SAVR.
This is a single center, retrospective cohort study of patients having Society of Thoracic Surgeons (STS)-defined urgent or emergent AVR for aortic stenosis with clinical signs and symptoms of shock. Inclusion criteria were based on the Society of Cardiovascular Angiography & Interventions (SCAI) shock consensus statement and included: the need for inotropic or vasopressor agents, mechanical ventilation, continuous renal replacement therapy or newly initiated hemodialysis, and/or utilization of mechanical hemodynamic support. Clinical and echocardiographic outcomes for TAVR and SAVR were compared.
Thirty-seven patients met the inclusion criteria for this study (17 TAVR, 20 SAVR). TAVR patients had a higher STS Predicted Risk of Mortality (PROM) score of 22.3% compared to 11.8% for SAVR patients (p = 0.001). No significant differences were found in baseline echocardiographic results. TAVR procedures required less procedure room time (185.9 min TAVR, 348.5 min SAVR, p < 0.001) and fewer intraoperative packed red blood cell (pRBC) transfusions (0.2 units TAVR, 3.4 units SAVR, p < 0.001). TAVR patients also had lower rates of prolonged postoperative ventilation compared to SAVR patients (38.5% TAVR, 75.0% SAVR, p = 0.047). TAVR and SAVR had similar rates of mortality at discharge (2 TAVR, 1 SAVR, p = 0.584), 30-days (2 TAVR, 1 SAVR, p = 0.584), and 1-year (8 TAVR, 5 SAVR, p = 0.149).
Despite a higher risk TAVR group, patients in shock undergoing either TAVR or SAVR have similar 30-day mortality. At one year, SAVR patients have a numerically better, though not statistically significant, survival. These findings support the use of TAVR for patients in shock with aortic stenosis.
比较经导管主动脉瓣置换术（TAVR）与外科主动脉瓣置换术（SAVR）在休克患者中的应用效果。
关于接受TAVR的休克患者的临床和超声心动图结果的数据极少，且没有将这些结果与接受SAVR的类似患者进行比较的数据。
这是一项单中心回顾性队列研究，研究对象为因主动脉狭窄且有休克临床体征和症状而接受胸外科医师协会（STS）定义的紧急或急诊主动脉瓣置换术（AVR）的患者。纳入标准基于心血管造影和介入学会（SCAI）休克共识声明，包括：需要使用血管活性药物、机械通气、持续肾脏替代治疗或新开始的血液透析，和/或使用机械血流动力学支持。比较了TAVR和SAVR的临床和超声心动图结果。
37例患者符合本研究的纳入标准（17例行TAVR，20例行SAVR）。TAVR患者的STS预测死亡风险（PROM）评分较高，为22.3%，而SAVR患者为11.8%（p = 0.001）。基线超声心动图结果未发现显著差异。TAVR手术所需的手术时间较短（TAVR为185.9分钟，SAVR为348.5分钟，p < 0.001），术中浓缩红细胞（pRBC）输注量较少（TAVR为0.2单位，SAVR为3.4单位，p < 0.001）。与SAVR患者相比，TAVR患者术后机械通气时间延长的发生率也较低（TAVR为38.5%，SAVR为75.0%，p = 0.047）。TAVR和SAVR出院时（2例TAVR，1例SAVR，p = 0.584）、30天时（2例TAVR，1例SAVR，p = 0.584）和1年时（8例TAVR，5例SAVR，p = 0.149）的死亡率相似。
尽管TAVR组风险较高，但接受TAVR或SAVR的休克患者30天死亡率相似。1年时，SAVR患者的生存率在数值上更好，但无统计学意义。这些发现支持在有主动脉狭窄的休克患者中使用TAVR。
