Division of Internal Medicine, Department of Medicine, Baylor College of Medicine, Houston, TX, USA.
Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA; Department of Cardiovascular Surgery, Texas Heart Institute, Houston, TX, USA.
Int J Cardiol. 2021 Apr 15;329:50-55. doi: 10.1016/j.ijcard.2020.12.054. Epub 2020 Dec 24.
Chest radiation therapy (CRT) for malignant thoracic neoplasms is associated with development of valvular heart disease years later. As previous radiation exposure can complicate surgical treatment, transcatheter aortic valve replacement (TAVR) has emerged as an alternative. However, outcomes data are lacking for TAVR patients with a history of CRT.
We conducted a retrospective study of all patients who underwent a TAVR procedure at a single institution between September 2012 and November 2018. Among 1341 total patients, 50 had previous CRT. These were propensity-matched in a 1:2 ratio to 100 patients without history of CRT. Thirty-day adverse events were analyzed with generalized estimating equation models. Overall mortality was analyzed with stratified Cox regression modelling.
Median clinical follow-up was 24 months (interquartile range [IQR], 12-44 months). There was no difference between CRT and non-CRT patients in overall mortality (hazard ratio [HR] 0.84 [0.37-1.90], P = 0.67), 30-day mortality (HR 3.1 [0.49-20.03], P = 0.23), or 30-day readmission rate (HR 1.0 [0.43-2.31], P = 1). There were no differences in the rates of most adverse events, but patients with CRT history had higher rates of postprocedural respiratory failure (HR 3.63 [1.32-10.02], P = 0.01) and permanent pacemaker implantation (HR 2.84 [1.15-7.01], P = 0.02).
For patients with aortic valve stenosis and previous CRT, TAVR is safe and effective, with outcomes similar to those in the general aortic stenosis population. Patients with history of CRT are more likely to have postprocedural respiratory failure and to require permanent pacemaker implantation.
胸部恶性肿瘤的放射治疗（CRT）会导致多年后出现瓣膜性心脏病。由于先前的辐射暴露会使手术治疗复杂化，经导管主动脉瓣置换术（TAVR）已成为一种替代方法。然而，对于有 CRT 病史的 TAVR 患者，缺乏相关的结局数据。
我们对 2012 年 9 月至 2018 年 11 月在一家机构接受 TAVR 手术的所有患者进行了回顾性研究。在 1341 例患者中，有 50 例有 CRT 病史。将这 50 例患者按 1：2 的比例与 100 例无 CRT 病史的患者进行倾向评分匹配。使用广义估计方程模型分析 30 天不良事件。使用分层 Cox 回归模型分析总体死亡率。
中位临床随访时间为 24 个月（四分位距 [IQR]，12-44 个月）。在总体死亡率（风险比 [HR] 0.84 [0.37-1.90]，P=0.67）、30 天死亡率（HR 3.1 [0.49-20.03]，P=0.23）和 30 天再入院率（HR 1.0 [0.43-2.31]，P=1）方面，CRT 组与非 CRT 组之间没有差异。大多数不良事件的发生率没有差异，但 CRT 病史患者的术后呼吸衰竭发生率较高（HR 3.63 [1.32-10.02]，P=0.01）和永久起搏器植入率较高（HR 2.84 [1.15-7.01]，P=0.02）。
对于主动脉瓣狭窄合并 CRT 病史的患者，TAVR 是安全有效的，其结局与一般主动脉瓣狭窄人群相似。有 CRT 病史的患者更有可能发生术后呼吸衰竭，并需要植入永久性起搏器。
