De Ronde-Tillmans M J A G, Nuis R M, Goudzwaard J A, Cummins P A, Hokken T W, Van Wiechen M P H, Ooms J F W, Daemen J, Van Mieghem N M D A, Mattace-Raso F U S, Lenzen M J, de Jaegere P P T
Department of Cardiology, Erasmus University Medical Centre, Rotterdam, The Netherlands.
Department of Internal Medicine, Section of Geriatrics, Erasmus University Medical Centre, Rotterdam, The Netherlands.
Neth Heart J. 2022 Sep;30(9):411-422. doi: 10.1007/s12471-022-01662-2. Epub 2022 Feb 25.
Transcatheter aortic valve implantation (TAVI) has matured to the treatment of choice for most patients with aortic stenosis (AS). We sought to identify trends in patient and procedural characteristics, and clinical outcomes in all patients who underwent TAVI between 2005 and 2020.
A single-centre analysis was performed on 1500 consecutive patients who underwent TAVI, divided into three tertiles (T) of 500 patients treated between November 2005 and December 2014 (T1), January 2015 and May 2018 (T2) and June 2018 and April 2020 (T3).
Over time, mean age and gender did not change (T1 to T3: 80, 80 and 79 years and 53%, 55% and 52% men, respectively), while the Society of Thoracic Surgeons risk score declined (T1: 4.5% to T3: 2.7%, p < 0.001). Use of general anaesthesia also declined over time (100%, 24% and 1% from T1 to T3) and transfemoral TAVI remained the default approach (87%, 94% and 92%). Median procedure time and contrast volume decreased significantly (186, 114 and 56 min and 120, 100 and 80 ml, respectively). Thirty-day mortality (7%, 4% and 2%), stroke (7%, 3% and 3%), need for a pacemaker (19%, 22% and 8%) and delirium (17%, 12% and 8%) improved significantly, while major bleeding/vascular complications did not change (both approximately 9%, 6% and 6%). One-year survival was 80%, 88% and 92%, respectively.
Over our 15 years' experience, patient age remained unchanged but the patient risk profile became more favourable. Simplification of the TAVI procedure occurred in parallel with major improvement in outcomes and survival. Bleeding/vascular complications and the need for pacemaker implantation remain the Achilles' heel of TAVI.
经导管主动脉瓣植入术（TAVI）已发展成为大多数主动脉瓣狭窄（AS）患者的首选治疗方法。我们试图确定2005年至2020年间接受TAVI治疗的所有患者的患者和手术特征趋势以及临床结局。
对1500例连续接受TAVI治疗的患者进行单中心分析，将其分为三个三分位数组（T），每组500例患者，分别为2005年11月至2014年12月治疗的患者（T1）、2015年1月至2018年5月治疗的患者（T2）以及2018年6月至2020年4月治疗的患者（T3）。
随着时间推移，平均年龄和性别没有变化（T1至T3组：分别为80岁、80岁和79岁，男性比例分别为53%、55%和52%），而胸外科医师协会风险评分下降（T1组：4.5%至T3组：2.7%，p<0.001）。全身麻醉的使用也随时间减少（从T1至T3组分别为100%、24%和1%），经股动脉TAVI仍然是默认方法（分别为87%、94%和92%）。中位手术时间和造影剂用量显著减少（分别为186分钟、114分钟和56分钟，以及120毫升、100毫升和80毫升）。30天死亡率（分别为7%、4%和2%）、卒中（分别为7%、3%和3%）、起搏器植入需求（分别为19%、22%和8%）和谵妄（分别为17%、12%和8%）显著改善，而大出血/血管并发症没有变化（均约为9%、6%和6%）。1年生存率分别为80%、88%和92%。
在我们15年的经验中，患者年龄保持不变，但患者风险状况变得更有利。TAVI手术的简化与结局和生存率的重大改善同时发生。出血/血管并发症和起搏器植入需求仍然是TAVI的致命弱点。
