Current affiliation: Physician, Indiana University School of Medicine, Indianapolis, IN, USA Institution where this work was completed: Marshfield Medical Center, Marshfield, Wisconsin.
Department of Internal Medicine, Marshfield Clinic Health System, Marshfield, WI USA.
Clin Med Res. 2021 Mar;19(1):10-18. doi: 10.3121/cmr.2020.1539. Epub 2020 Oct 14.
Transcatheter aortic valve replacement (TAVR) is a rapidly evolving treatment for severe aortic stenosis. However, uncertainties exist for optimal valve selection as there are few long-term studies comparing patient survival by valve type. We hypothesized that self-expandable valves (SEV) would provide a survival advantage over balloon expandable valves (BEV), as SEV continue to expand and might better accommodate to the anatomy of the aortic valve over time. We examined outcomes according to valve type from a rural tertiary referral center between 2012 and 2017. Out of 269 patients, 77 deaths (28.6%) occurred over the study period with 6 deaths by 1 month post-TAVR and 37 deaths by 1 year post-TAVR. The median observation time for survivors was 21.5 months. The probability of survival at 3 years was 60.7% and 61.9% for patients who underwent treatment with SEV and BEV, respectively. There was no statistically significant difference in overall patient survival with or without adjustment for factors such as age, sex, race, and aortic valve area. Additionally, in a secondary analysis restricted to those patients treated in later years (2015-2017) survival among patients with BEV appeared superior (HR=0.456, P=0.015). Patients who underwent TAVR at a rural medical center with SEV showed similar survival compared to those who received a BEV. Superior survival was observed among those who received BEV versus SEV between 2015 and 2017.
经导管主动脉瓣置换术（TAVR）是一种治疗严重主动脉瓣狭窄的快速发展的方法。然而，由于缺乏比较不同瓣膜类型患者生存情况的长期研究，瓣膜的最佳选择仍存在不确定性。我们假设自膨式瓣膜（SEV）在生存方面优于球囊扩张式瓣膜（BEV），因为 SEV 会持续扩张，并随着时间的推移更好地适应主动脉瓣的解剖结构。我们根据瓣膜类型对 2012 年至 2017 年期间一个农村三级转诊中心的患者结局进行了研究。在 269 名患者中，研究期间有 77 例死亡（28.6%），其中 6 例在 TAVR 后 1 个月内死亡，37 例在 TAVR 后 1 年内死亡。幸存者的中位观察时间为 21.5 个月。接受 SEV 和 BEV 治疗的患者在 3 年时的生存率分别为 60.7%和 61.9%。在不考虑年龄、性别、种族和主动脉瓣面积等因素调整的情况下，患者的总生存率没有统计学差异。此外，在仅对较晚年份（2015-2017 年）接受治疗的患者进行的二次分析中，BEV 治疗患者的生存率似乎更高（HR=0.456，P=0.015）。在农村医疗中心接受 SEV 治疗的 TAVR 患者的生存率与接受 BEV 治疗的患者相似。在 2015 年至 2017 年期间，接受 BEV 治疗的患者与接受 SEV 治疗的患者相比，生存率更高。
