The Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
Catheter Cardiovasc Interv. 2021 Feb 15;97(3):E418-E424. doi: 10.1002/ccd.29117. Epub 2020 Jul 1.
This study aimed to assess the feasibility and safety of conducting an entire transcatheter aortic valve replacement (TAVR) program by using percutaneous techniques only.
Surgically assisted transthoracic TAVR has been reported to be associated with more complications and longer hospital stays.
During 2019, all TAVR at a single center were performed by standard transfemoral (TF), intravascular lithotripsy-assisted TF, transaxillary (TAx), or transcaval approach using percutaneous techniques only. No patients were denied TAVR because of access. Procedural and clinical endpoints were categorized using Valve Academic Research Consortium-2 criteria.
In total, 306 consecutive TAVR patients were enrolled (mean age 78.9 ± 7.2 years). Most patients were treated by TF approach (94.8%)-of these, nine (2.9%) were pre-treated with intravascular lithotripsy. A percutaneous TAx and transcaval approach were used in 12 (3.9%) and four patients (1.3%), respectively. There were no procedural deaths and one peri-procedural stroke. Valve performance was satisfying in 298 patients (97.4%); six patients had a moderate aortic regurgitation and two patients had a mean gradient ≥20 mmHg following valve-in-valve procedure. The 30-day major vascular complication and major bleeding rate was 2.3% and 3.9%, respectively. A new permanent pacemaker was implanted in 41 patients (13.4%). Of all patients, 81% were discharged within two days post-TAVR, including 11 out of 12 TAx patients and all transcaval cases.
A fully percutaneous TAVR program is feasible and safe with favorable immediate and early clinical outcomes and allowing a short hospital stay.
本研究旨在评估仅采用经皮技术完成整个经导管主动脉瓣置换术（TAVR）的可行性和安全性。
经胸外科辅助 TAVR 与更多并发症和更长的住院时间相关。
在 2019 年期间，在一家中心，所有 TAVR 均通过标准经股动脉（TF）、血管内碎石辅助 TF、经腋动脉（TAx）或经腔静脉途径，仅采用经皮技术进行。没有因通路问题而拒绝 TAVR 的患者。使用 Valve Academic Research Consortium-2 标准对程序和临床终点进行分类。
共纳入 306 例连续 TAVR 患者（平均年龄 78.9±7.2 岁）。大多数患者接受 TF 入路治疗（94.8%）-其中 9 例（2.9%）预先接受了血管内碎石治疗。12 例（3.9%）和 4 例（1.3%）患者分别采用经皮 TAx 和经腔静脉途径。无手术死亡和 1 例围手术期卒中。298 例（97.4%）瓣膜功能满意；6 例患者经瓣中瓣手术后出现中度主动脉瓣反流，2 例患者平均梯度≥20mmHg。30 天主要血管并发症和主要出血发生率分别为 2.3%和 3.9%。41 例（13.4%）患者植入新的永久性起搏器。所有患者中，81%在 TAVR 后 2 天内出院，包括 12 例 TAx 患者中的 11 例和所有经腔静脉病例。
完全经皮 TAVR 方案可行且安全，具有良好的即刻和早期临床结果，并允许缩短住院时间。
