经导管主动脉瓣中瓣植入术与再次主动脉瓣置换术治疗主动脉生物瓣衰败的早期和中期临床结局：一枚硬币的两面。
Early and Midterm Clinical Outcomes of Transcatheter Valve-in-Valve Implantation Versus Redo Surgical Aortic Valve Replacement for Aortic Bioprosthetic Valve Degeneration: Two Faces of the Same Medal.
机构信息
Cardiac Surgery Department, Saint Michael's Hospital, Toronto, Canada; Cardiac Surgery, CARIM, Maastricht University Medical Center, Maastricht, Netherlands.
Le Scotte Hospital, University of Siena, Siena, Italy.
出版信息
J Cardiothorac Vasc Anesth. 2021 Nov;35(11):3223-3231. doi: 10.1053/j.jvca.2021.05.029. Epub 2021 May 24.
OBJECTIVE
To compare early and midterm outcomes of transcatheter valve-in-valve implantation (ViV-TAVI) and redo surgical aortic valve replacement (re-SAVR) for aortic bioprosthetic valve degeneration.
DESIGN
Patients who underwent ViV-TAVI and re-SAVR for aortic bioprosthetic valve degeneration between January 2010 and October 2018 were retrospectively analyzed. Mean follow-up was 3.0 years.
SETTING
In-hospital, early, and mid-term outcomes.
PARTICIPANTS
Eighty-eight patients were included in the analysis.
INTERVENTIONS
Thirty-one patients (37.3%) had ViV-TAVI, and 57 patients (62.7%) had re-SAVR.
MEASUREMENTS AND MAIN RESULTS
In the ViV-TAVI group, patients were older (79.1 ± 7.4 v 67.2 ± 14.1, p < 0.01). The total operative time, intubation time, intensive care unit length of stay, total hospital length of stay, inotropes infusion, intubation >24 hours, total amount of chest tube losses, red blood cell transfusions, plasma transfusions, and reoperation for bleeding were significantly higher in the re-SAVR cohort (p < 0.01). There was no difference regarding in-hospital permanent pacemaker implantation (ViV-TAVI = 3.2% v re-SAVR = 8.8%, p = 0.27), patient-prosthesis mismatch (ViV-TAVI = 12 patients [mean 0.53 ± 0.07] and re-SAVR = ten patients [mean 0.56 ± 0.08], p = 0.4), stroke (ViV-TAVI = 3.2% v re-SAVR = 7%, p = 0.43), acute kidney injury (ViV-TAVI = 9.7% v re-SAVR = 15.8%, p = 0.1), and all-cause infections (ViV-TAVI = 0% v re-SAVR = 8.8%, p = 0.02), between the two groups. In-hospital mortality was 0% and 7% for ViV-TAVI and re-SAVR, respectively (p = 0.08). At three-years' follow-up, the incidence of pacemaker implantation was higher in the re-SAVR group (ViV-TAVI = 0 v re-SAVR = 13.4%, p < 0.01). There were no differences in reintervention (ViV-TAVI = 3.8% v re-SAVR = 0%, p = 0.32) and survival (ViV-TAVI = 83.9% v re-SAVR = 93%, p = 0.10) between the two cohorts.
CONCLUSIONS
ViV-TAVI is a safe, feasible, and reliable procedure.
目的
比较经导管主动脉瓣置换术（ViV-TAVI）和再次主动脉瓣置换术（re-SAVR）治疗生物瓣主动脉瓣退行性变的早期和中期结果。
设计
回顾性分析 2010 年 1 月至 2018 年 10 月期间因生物瓣主动脉瓣退行性变接受 ViV-TAVI 和 re-SAVR 的患者。平均随访 3.0 年。
地点
院内、早期和中期结果。
参与者
共 88 例患者纳入分析。
干预措施
31 例（37.3%）患者接受 ViV-TAVI，57 例（62.7%）患者接受 re-SAVR。
测量和主要结果
ViV-TAVI 组患者年龄较大（79.1±7.4 岁比 67.2±14.1 岁，p<0.01）。re-SAVR 组患者的总手术时间、插管时间、重症监护病房住院时间、总住院时间、正性肌力药物输注、插管>24 小时、总胸腔引流管失血量、红细胞输注、血浆输注和再次出血手术的数量均显著高于 ViV-TAVI 组（p<0.01）。两组在院内永久性起搏器植入（ViV-TAVI 3.2%比 re-SAVR 8.8%，p=0.27）、患者-人工瓣膜不匹配（ViV-TAVI 12 例[平均 0.53±0.07]，re-SAVR 10 例[平均 0.56±0.08]，p=0.4）、卒（ViV-TAVI 3.2%比 re-SAVR 7%，p=0.43）、急性肾损伤（ViV-TAVI 9.7%比 re-SAVR 15.8%，p=0.1）和全因感染（ViV-TAVI 0%比 re-SAVR 8.8%，p=0.02）方面无差异。两组院内死亡率分别为 0%和 7%（p=0.08）。在 3 年随访时，re-SAVR 组的起搏器植入发生率更高（ViV-TAVI 0%比 re-SAVR 13.4%，p<0.01）。两组再干预（ViV-TAVI 3.8%比 re-SAVR 0%，p=0.32）和生存率（ViV-TAVI 83.9%比 re-SAVR 93%，p=0.10）无差异。
结论
ViV-TAVI 是一种安全、可行和可靠的方法。
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