Allen Keith B, Chhatriwalla Adnan K, Saxon John, Hermiller James, Heimansohn David, Moainie Sina, McKay Raymond G, Cheema Mohiuddin, Jones Brandon, Hodson Robert W, Korngold Ethan, Kirker Eric
Saint Luke's Hospital, Saint Luke's Mid America Heart Institute, Kansas City, Mo.
Saint Luke's Hospital, Saint Luke's Mid America Heart Institute, Kansas City, Mo.
J Thorac Cardiovasc Surg. 2022 Aug;164(2):506-515. doi: 10.1016/j.jtcvs.2020.09.133. Epub 2020 Oct 21.
Transcarotid access for transcatheter aortic valve replacement is emerging as an alternative to more traditional nonfemoral access options such as transapical or transaortic; however, comparative data are limited. The purpose of the study was to analyze outcomes after transcatheter aortic valve replacement using transcatheter compared with transthoracic (transapical/transaortic) access.
The Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry was queried for patients who underwent transcarotid, transapical, or transaortic transcatheter aortic valve replacement with the SAPIEN 3 (Edwards Lifesciences, Irvine, Calif) transcatheter heart valve between June 2015 and July 2019. Thirty-day unadjusted outcomes were evaluated, and propensity score matching and logistic regression were used to compare transcatheter access with transthoracic access.
In the propensity-matched analysis, 667 transcarotid transcatheter aortic valve replacement procedures were compared with 1334 transthoracic procedures. Transcarotid transcatheter aortic valve replacement was associated with lower mortality (4.2% vs 7.7%, P = .004), less new-onset atrial fibrillation (2.2% vs 12.1%, P < .0001), fewer readmissions at 30 days (9.8% vs 16.1%, P = .0006), shorter median length of stay (3.0 vs 6.0 days, P < .0001), shorter median intensive care unit stay (25 vs 47.2 hours, P < .0001), and greater 30-day Kansas City Cardiomyopathy Questionnaire score improvement from baseline (25.1 vs 20.8, P = .007). Stroke (4.3% vs 3.7%, P = .44) and major vascular complications (1.4% vs 1.9%, P = .40) were similar.
Transcatheter aortic valve replacement using transcarotid access is associated with lower 30-day mortality, less atrial fibrillation, shorter intensive care unit and overall length of stay, fewer readmissions, greater improvement in Kansas City Cardiomyopathy Questionnaire scores, and no significant difference in stroke or major vascular complications compared with transthoracic access.
经颈动脉途径行经导管主动脉瓣置换术正逐渐成为经心尖或经主动脉等更传统的非股动脉途径的替代方法；然而，比较数据有限。本研究的目的是分析经导管与经胸（经心尖/经主动脉）途径行经导管主动脉瓣置换术后的结果。
查询胸外科医师协会/美国心脏病学会经导管瓣膜治疗注册中心，获取2015年6月至2019年7月期间使用SAPIEN 3（爱德华生命科学公司，加利福尼亚州欧文市）经导管心脏瓣膜行颈动脉、经心尖或经主动脉经导管主动脉瓣置换术的患者。评估30天未调整的结果，并使用倾向评分匹配和逻辑回归比较经导管途径与经胸途径。
在倾向评分匹配分析中，667例经颈动脉经导管主动脉瓣置换手术与1334例经胸手术进行了比较。经颈动脉经导管主动脉瓣置换术与较低的死亡率相关（4.2%对7.7%，P = 0.004），新发房颤较少（2.2%对12.1%，P < 0.0001），30天再入院率较低（9.8%对16.1%，P = 0.0006），中位住院时间较短（3.0天对6.0天，P < 0.0001），中位重症监护病房住院时间较短（25小时对47.2小时，P < 0.0001），以及30天时堪萨斯城心肌病问卷评分较基线有更大改善（25.1对20.8，P = 0.007）。卒中（4.3%对3.7%，P = 0.44）和主要血管并发症（1.4%对1.9%，P = 0.40）相似。
与经胸途径相比，经颈动脉途径行经导管主动脉瓣置换术与30天死亡率较低、房颤较少、重症监护病房和总住院时间较短、再入院率较低、堪萨斯城心肌病问卷评分改善更大以及卒中和主要血管并发症无显著差异相关。
