Department of Cardiovascular Surgery, German Heart Center Munich, TUM, Munich, Germany.
linic for Thoracic and Cardiovascular Surgery Heart and Diabetes Center NRW, Bad Oeynhausen, Germany.
Heart Surg Forum. 2020 Aug 28;23(5):E611-E616. doi: 10.1532/hsf.3129.
Perioperative mortality is high and long-term survival is poor for patients on hemodialysis undergoing surgical aortic valve replacement (SAVR). Transcatheter aortic valve replacement (TAVR) offers a safe and effective therapy for high-risk patients suffering from aortic valve stenosis. However, in patients on hemodialysis only limited information is available on the outcome following TAVR.
Of the 2613 consecutive patients in our single-center TAVR registry, all hemodialysis patients, were identified. Demographics, procedural details, clinical outcomes, mortality, and complications were evaluated.
Forty-two hemodialysis patients with a mean age of 75.2±8.2 years, a mean STS predicted risk of mortality of 11.1±9.5% and a mean logEuroScore of 27.9±18.8% underwent TAVR. Mean duration on hemodialysis prior to intervention was 62.8±49.6 months. A transfemoral access was chosen in 24 patients, a transapical in 16, and a transaxillary and a transaortic in one patient, respectively. Estimated survival at 30 days, one, three and five years was 83.3%, 68.3%, 37.7% and 18.9%, respectively. Estimated median survival was 1.8±0.4 years. VARC-2 defined perioperative complications included stroke in 7.1% (3/42), major bleeding in 16.7% (7/42), and vascular complications in 7.1% (3/42). In two patients, echocardiographic examination at three and four years, respectively, showed evidence for structural valve deterioration.
A high number of patients with ESRD undergoing TAVR require a non-transfemoral access. Predominantly, bleeding events contribute to the perioperative morbidity. An estimated median survival of less than two years after TAVR allows only limited assessment of valve prosthesis durability. Cardiovascular and non-cardiovascular mortality contribute equally to the causes of death beyond the first year after TAVR.
接受手术主动脉瓣置换术（SAVR）的血液透析患者围手术期死亡率高，长期生存率低。经导管主动脉瓣置换术（TAVR）为患有主动脉瓣狭窄的高危患者提供了一种安全有效的治疗方法。然而，在血液透析患者中，关于 TAVR 后结果的信息有限。
在我们的单中心 TAVR 注册中心的 2613 例连续患者中，确定了所有血液透析患者。评估了人口统计学、程序细节、临床结果、死亡率和并发症。
42 例血液透析患者，平均年龄 75.2±8.2 岁，平均 STS 预测死亡率为 11.1±9.5%，平均 logEuroScore 为 27.9±18.8%，接受了 TAVR。介入前血液透析的平均时间为 62.8±49.6 个月。24 例患者选择经股动脉入路，16 例患者选择经心尖入路，1 例患者分别选择经腋动脉和经主动脉入路。30 天、1 年、3 年和 5 年的估计生存率分别为 83.3%、68.3%、37.7%和 18.9%。估计中位生存时间为 1.8±0.4 年。VARC-2 定义的围手术期并发症包括 7.1%（3/42）的卒中、16.7%（7/42）的大出血和 7.1%（3/42）的血管并发症。在两名患者中，分别在 3 年和 4 年进行的超声心动图检查显示出结构性瓣膜恶化的证据。
接受 TAVR 的大量 ESRD 患者需要非经股动脉入路。主要是出血事件导致围手术期发病率增加。TAVR 后估计中位生存时间不到两年，仅允许对瓣膜假体耐久性进行有限评估。TAVR 后第一年以外的心血管和非心血管死亡率对死亡原因的贡献相等。
