严重主动脉瓣狭窄患者经心尖经导管主动脉瓣植入术的12个月结局
Twelve-month outcomes of transapical transcatheter aortic valve implantation in patients with severe aortic valve stenosis.
作者信息
Wiewiórka Łukasz, Sobczyński Robert, Trębacz Jarosław, Sadowski Jerzy, Dudek Dariusz, Stąpór Maciej, Konstanty-Kalandyk Janusz, Musiał Robert, Gackowski Andrzej, Malinowski Krzystof, Kleczyński Paweł, Żmudka Krzysztof, Kapelak Bogusław, Legutko Jacek
机构信息
Department of Interventional Cardiology, John Paul II Hospital, Krakow, Poland.
Department of Cardiac Surgery and Transplantation, John Paul II Hospital, Krakow, Poland.
出版信息
Postepy Kardiol Interwencyjnej. 2021 Mar;17(1):68-74. doi: 10.5114/aic.2021.104771. Epub 2021 Mar 27.
INTRODUCTION
Transapical access (TA) transcatheter aortic valve implantation (TAVI) (TA-TAVI) represents one of the possible routes in patients with severe aortic stenosis (AS) who are not suitable for transfemoral access.
AIM
To assess early- and mid-term clinical outcomes after TA-TAVI.
MATERIAL AND METHODS
Patients with severe symptomatic AS undergoing TA-TAVI from November 2008 to December 2019 were enrolled. Clinical and procedural characteristics as well as clinical outcomes including all-cause mortality during 12-month follow-up were assessed.
RESULTS
Sixty-one consecutive patients underwent TA-TAVI for native AS. Patients were elderly with median age of 80.0 (76.0-84.0) years; 55.7% were males. Median baseline EuroSCORE I and STS scores were 18.2% (11.6-27.7) and 4.8% (3.3-8.2), respectively. The procedural success rate was 96.7%. In-hospital, 30-day and 12-month mortality rates were 9.8%; 18.0% and 24.6%, respectively. The main periprocedural and in-hospital complications were bleeding complications (14.8%). The following factors were associated with 12-month mortality: previous cerebrovascular event (CVE), glomerular filtration rate (GFR), aortic valve area (AVA), right ventricular systolic pressure (RVSP) and serum level of N-terminal prohormone of brain natriuretic peptide (NT-proBNP) (RR for CVE 3.17, 95% confidence interval (CI): 1.15-8.76: = 0.026; RR for AVA per 0.1 cm 1.28, 95% CI: 1.03-1.55: = 0.024; RR for GFR per 1 ml/min 0.96: 95% CI: 0.94-0.99: = 0.007; RR for NT-proBNP per 1000 pg/ml 1.07: 95% CI: 1.01-1.17: = 0.033; RR for RVSP per 1 mm Hg 1.07: 95% CI 1.02-1.16: = 0.011).
CONCLUSIONS
Transapical TAVI in high-risk patients provides good hemodynamic results with acceptable outcomes.
引言
经心尖入路经导管主动脉瓣植入术（TA-TAVI）是重度主动脉瓣狭窄（AS）且不适合经股动脉入路患者的可行途径之一。
目的
评估TA-TAVI术后的早期和中期临床结局。
材料与方法
纳入2008年11月至2019年12月期间接受TA-TAVI的重度有症状AS患者。评估临床和手术特征以及包括12个月随访期间全因死亡率在内的临床结局。
结果
61例连续性患者接受了TA-TAVI治疗原发性AS。患者年龄较大，中位年龄为80.0（76.0-84.0）岁；55.7%为男性。EuroSCORE I和STS评分的基线中位数分别为18.2%（11.6-27.7）和4.8%（3.3-8.2）。手术成功率为96.7%。住院、30天和12个月死亡率分别为9.8%、18.0%和24.6%。围手术期和住院期间的主要并发症是出血并发症（14.8%）。以下因素与12个月死亡率相关：既往脑血管事件（CVE）、肾小球滤过率（GFR）、主动脉瓣面积（AVA）、右心室收缩压（RVSP）和脑钠肽N末端前体激素（NT-proBNP）血清水平（CVE的风险比3.17，95%置信区间（CI）：1.15-8.76：P = 0.026；AVA每0.1 cm的风险比1.28，95%CI：1.03-1.55：P = 0.024；GFR每1 ml/min的风险比0.96：95%CI：0.94-0.99：P = 0.007；NT-proBNP每1000 pg/ml的风险比1.07：95%CI：1.01-1.17：P = 0.033；RVSP每1 mmHg的风险比1.07：95%CI 1.02-1.16：P = 0.011）。
结论
高危患者经心尖TAVI可提供良好的血流动力学结果，结局可接受。
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