Queensland Heart Institute, Brisbane, Qld, Australia; Cardiovascular Clinics, Brisbane, Qld, Australia; University of Queensland, Brisbane, Qld, Australia; St Andrew's War Memorial Hospital, Brisbane, Qld, Australia.
St Andrew's War Memorial Hospital, Brisbane, Qld, Australia.
Heart Lung Circ. 2020 Oct;29(10):1534-1541. doi: 10.1016/j.hlc.2020.03.010. Epub 2020 Apr 8.
Transcatheter aortic valve implantation (TAVI) was first performed in Australia in 2008 with a steady increase in the number of implanting centres from seven in 2008 to 42 in 2018 (24 private and 18 public hospitals). There is limited published data on outcomes from Australian centres and no published data from Australian private hospitals. We describe outcomes of the first 300 cases at Queensland's first TAVI implanting private hospital.
From July 2015 to August 2018, 300 patients with severe, symptomatic aortic stenosis underwent TAVI at our centre. A heart team assessed all patients as suitable. All patients underwent computed tomography (CT) assessment of valve sizing and peripheral access.
Median age was 85 years, 58% male, mean Society of Thoracic Surgeons' score 4.0%, 49% had New York Heart Association Class III/IV, 28% previous coronary artery bypass grafts, 14% peripheral vascular disease and 3.7% renal impairment (creatinine >177 μmol/L). At 30 days mortality was 1%, stroke 1.3%, myocardial infarction (MI) 0.3%, major vascular complication 3.0%, no life-threatening or disabling bleeding and new permanent pacemaker (PPM) requirement was 9.0%. Paravalvular leak was none, trace and mild in 27%, 53% and 20% respectively with 0.3%≥moderate paravalvular leak. At 1 year, mortality was 4.2%, stroke 2.1%, MI 0.3%, no life-threatening bleeding and PPM 11.4%. Lower rates of mortality, stroke, and major vascular complications were observed compared to the well-established TAVI centres in USA and Germany.
Excellent TAVI clinical outcomes can be achieved in the Australian private hospital setting. Expert heart team assessment and CT guided procedural planning are key to these outcomes.
经导管主动脉瓣植入术（TAVI）于 2008 年在澳大利亚首次实施，植入中心数量从 2008 年的 7 个稳步增加到 2018 年的 42 个（24 家私立医院和 18 家公立医院）。关于澳大利亚中心的结果，发表的数据有限，也没有来自澳大利亚私立医院的数据。我们描述了昆士兰州第一家 TAVI 植入私立医院前 300 例患者的结果。
从 2015 年 7 月至 2018 年 8 月，我们中心对 300 例严重、有症状的主动脉瓣狭窄患者进行了 TAVI。一个心脏团队评估了所有患者是否适合。所有患者均接受了计算断层扫描（CT）评估瓣膜尺寸和外周通路。
中位年龄为 85 岁，58%为男性，平均胸外科医师协会评分 4.0%，49%为纽约心脏协会心功能分级 III/IV 级，28%有既往冠状动脉旁路移植术，14%有外周血管疾病，3.7%有肾功能损害（肌酐＞177 μmol/L）。30 天死亡率为 1%，卒中 1.3%，心肌梗死（MI）0.3%，大血管并发症 3.0%，无危及生命或致残性出血，新植入永久性起搏器（PPM）的需求为 9.0%。瓣周漏为无、微量和轻度分别占 27%、53%和 20%，0.3%为中度以上瓣周漏。1 年死亡率为 4.2%，卒中 2.1%，MI 0.3%，无危及生命的出血，PPM 为 11.4%。与美国和德国成熟的 TAVI 中心相比，死亡率、卒中和大血管并发症的发生率较低。
在澳大利亚私立医院环境下可以获得出色的 TAVI 临床结果。专家心脏团队评估和 CT 引导的手术规划是实现这些结果的关键。
