Gennari Marco, Rigoni Marta, Mastroiacovo Giorgio, Trabattoni Piero, Roberto Maurizio, Bartorelli Antonio L, Fabbiocchi Franco, Tamborini Gloria, Muratori Manuela, Fusini Laura, Pepi Mauro, Muti Paola, Polvani Gianluca, Agrifoglio Marco
Department of Cardiovascular Surgery, IRCCS Centro Cardiologico Monzino, 20100 Milan, Italy.
Department of Industrial Engineering, University of Trento, 38100 Trento, Italy.
J Clin Med. 2021 Feb 25;10(5):909. doi: 10.3390/jcm10050909.
Transcatheter aortic valve replacement (TAVR) is an established technique to treat severe symptomatic aortic stenosis patients with a wide range of surgical risk. Currently, the common femoral artery is the first choice as the main access route for the procedure. The objective of this observational study is to report our experience on percutaneous and surgical cut-down transfemoral TAVRs comparing the two approaches.
From January 2014 to January 2019, five hundred eleven consecutive patients underwent TAVR for severe symptomatic aortic stenosis. We analyzed only elective transfemoral procedures. After propensity score-matching based on age, sex, EuroSCORE II, mean aortic gradient, and left ventricular ejection fraction, we obtained two homogeneous populations: surgical cut-down ( = 119) and percutaneous ( = 225), which were labeled Group 1 and Group 2, respectively.
The main findings were that there were no significant procedural outcome differences between the two groups, but Group 2 patients had a shorter length of hospital stay and were more frequently discharged home. At follow-up, Group 1 patients had lower survival rates.
An accurate preoperative assessment of the femoral access is mandatory to achieve satisfactory outcomes with transfemoral TAVRs. Nevertheless, the percutaneous approach allows shorter in-hospital stay and the need for rehabilitation, thus potentially decreasing the costs of the procedure.
经导管主动脉瓣置换术（TAVR）是一种成熟的技术，用于治疗具有广泛手术风险的重度症状性主动脉瓣狭窄患者。目前，股总动脉是该手术主要入路的首选。本观察性研究的目的是报告我们在经皮和外科切开股动脉TAVR方面的经验，并比较这两种方法。
2014年1月至2019年1月，511例连续患者因重度症状性主动脉瓣狭窄接受了TAVR。我们仅分析择期经股动脉手术。基于年龄、性别、欧洲心脏手术风险评估系统II（EuroSCORE II）、平均主动脉瓣压差和左心室射血分数进行倾向得分匹配后，我们获得了两个同质人群：外科切开组（n = 119）和经皮组（n = 225），分别标记为第1组和第2组。
主要发现是两组之间的手术结局无显著差异，但第2组患者住院时间较短，且更频繁地出院回家。在随访中，第1组患者的生存率较低。
对股动脉入路进行准确的术前评估对于经股动脉TAVR取得满意结局至关重要。尽管如此，经皮方法可缩短住院时间并减少康复需求，从而可能降低手术成本。
