John Ochsner Heart and Vascular Center, New Orleans, LA.
John Ochsner Heart and Vascular Center, New Orleans, LA.
Curr Probl Cardiol. 2021 Mar;46(3):100624. doi: 10.1016/j.cpcardiol.2020.100624. Epub 2020 May 22.
There is an increasing need for alternative access in patients with prohibitive surgical risk who have unsuitable anatomy for transfemoral transcatheter aortic valve replacement (TAVR). Data on differences in periprocedural outcomes via alternative access sites are scarce. We performed a retrospective analysis of patients who underwent Transaxillary (TAX) or Transapical (TAP) TAVR at our center from 2012 to 2019. All data was summarized and displayed as mean ± SD for continuous variables and number of patients in each group. A propensity score was created for each patient in the dataset to determine the probability of axillary vs apical access. We adjusted for propensity score using multivariate logistic regression. A total of 102 patients underwent TAVR via alternative access: 28 patients (27%) via TAX and 74 patients (73%) via transapical (TAP) access. The average time to extubation in the TAX group was 5.3 ± 3.5 hours vs 9.1 ± 8.8 hours in the TAP patients (P = 0.03). None of the TAX patients required reintubation compared to 23% of TAP TAVR (P = 0.003). The average hospital length of stay for TAX was 2.4 ± 2.0 days compared to 6.9 ± 3.3 days (P < 0.0001) for TAP. TAX TAVR patients had significantly lower re-intubation rates, shorter time to extubation and in-hospital length of stay, but higher pacemaker implantation rates. TAX TAVR had improved periprocedural outcomes compared to TAP TAVR and remains the preferred TAVR alternative access.
在因手术风险过高而不适合经股动脉经导管主动脉瓣置换术（TAVR）的患者中，对替代入路的需求日益增加。关于通过替代入路的围手术期结果差异的数据很少。我们对 2012 年至 2019 年在我们中心接受经腋（TAX）或经心尖（TAP）TAVR 的患者进行了回顾性分析。所有数据均以连续变量的平均值±标准差和每组患者的数量进行总结和显示。为数据集内的每位患者创建了倾向评分，以确定腋入路与心尖入路的可能性。我们使用多元逻辑回归来调整倾向评分。共有 102 名患者通过替代入路接受 TAVR：28 名患者（27%）通过 TAX，74 名患者（73%）通过经心尖（TAP）入路。TAX 组的平均拔管时间为 5.3±3.5 小时，TAP 组为 9.1±8.8 小时（P=0.03）。与 TAP TAVR 患者相比，TAX 组无一例患者需要重新插管（P=0.003）。TAX 的平均住院时间为 2.4±2.0 天，而 TAP 为 6.9±3.3 天（P<0.0001）。TAX TAVR 患者的再插管率、拔管时间和住院时间明显更短，但心脏起搏器植入率更高。与 TAP TAVR 相比，TAX TAVR 的围手术期结果更好，仍是首选的 TAVR 替代入路。
