Department of Cardiothoracic Surgery, Jena University Hospital, Friedrich Schiller University of Jena, Jena, Germany.
Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Centre North Rhine Westphalia, Bad Oeynhausen, Germany.
Clin Res Cardiol. 2021 Mar;110(3):357-367. doi: 10.1007/s00392-020-01717-7. Epub 2020 Sep 23.
The aim of this study was to compare outcomes of transcatheter and surgical aortic valve implantation in chronic dialysis patients with aortic valve stenosis (AS).
Chronic dialysis patients undergoing heart valve surgery are at higher risk for morbidity and mortality. Whether interventional techniques can reduce this risk is unclear because dialysis patients have thus far been excluded from randomized trials.
Chronic dialysis patients with AS enrolled in the German Aortic Valve Registry (GARY) between 2012 and 2015 were analyzed to compare transcatheter aortic valve implantation (TAVI n = 661) with surgical aortic valve replacement (SAVR n = 457). Propensity scores for inverse probability of treatment weighting (IPTW) were used to adjust the comparison of the two treatment groups for potential confounders.
TAVI patients were older (78 ± 7.3 vs. 69 ± 10.2 years, p < 0.01, unadjusted) and had more comorbidities. Mortality at 1 year was the same (TAVI: 33.4% vs. SAVR 35.0%, p = 0.72, IPTW-adjusted) while it was lower with TAVI at 30 days (8.6% vs. 15.0%, p = 0.02, IPTW-adjusted). TAVI patients required more pacemaker implantation and showed more aortic regurgitation. SAVR patients required more blood transfusions and had longer hospital stay. Diabetes mellitus, atrial fibrillation, previous PCI, urgent procedure and EuroSCORE were associated with elevated 30-day mortality. Atrial fibrillation and older age were independent risk factor of 1-year mortality in both groups.
Chronic dialysis patients with AS undergoing TAVI or SAVR had the same 1-year mortality, although survival at 30 days was better with TAVI. These results suggest that TAVI may improve peri-procedural outcomes.
本研究旨在比较慢性透析主动脉瓣狭窄（AS）患者行经导管主动脉瓣植入术（TAVI）和外科主动脉瓣置换术（SAVR）的结局。
接受心脏瓣膜手术的慢性透析患者的发病率和死亡率较高。由于透析患者迄今为止被排除在随机试验之外，介入技术是否可以降低这种风险尚不清楚。
分析了 2012 年至 2015 年期间德国主动脉瓣登记处（GARY）中纳入的慢性透析 AS 患者，比较 TAVI（n=661）与 SAVR（n=457）。采用逆概率治疗加权（IPTW）的倾向评分来调整两组之间的比较，以调整潜在混杂因素。
TAVI 患者年龄较大（78±7.3 岁 vs. 69±10.2 岁，p<0.01，未校正），合并症更多。1 年死亡率相同（TAVI：33.4% vs. SAVR：35.0%，p=0.72，IPTW 校正），但 30 天死亡率较低（8.6% vs. 15.0%，p=0.02，IPTW 校正）。TAVI 患者需要更多的起搏器植入，并显示更多的主动脉瓣反流。SAVR 患者需要更多的输血，且住院时间更长。糖尿病、房颤、既往 PCI、紧急手术和 EuroSCORE 与 30 天死亡率升高相关。房颤和年龄较大是两组 1 年死亡率的独立危险因素。
接受 TAVI 或 SAVR 的慢性透析 AS 患者的 1 年死亡率相同，尽管 TAVI 术后 30 天的存活率更高。这些结果表明 TAVI 可能改善围手术期结局。
