Department of Cardiology, CHU Rouen, U1096, Normandie University, UNIROUEN, 76000 Rouen, France.
Department of Cardiac Surgery, CHU Rouen, 76000 Rouen, France.
Arch Cardiovasc Dis. 2022 Apr;115(4):196-205. doi: 10.1016/j.acvd.2022.03.004. Epub 2022 Apr 29.
Since the first-in-man implantation of a transcatheter aortic stented valve in April 2002 in Rouen, the procedure has expanded worldwide. In our centre, all transfemoral procedures have been performed using local anaesthesia without transoesophageal echocardiographic monitoring.
To report our experience of transfemoral arterial transcatheter aortic valve implantation (TAVI) over the last 2 decades, following the evolution of devices, practices and indications.
Between 2002 and 2021, 2097 consecutive patients had a TAVI procedure in our centre. Among them, 1780 underwent transfemoral arterial aortic valve implantation, and were subdivided into three groups according to the time period: before 2009; 2009-2014; and 2014-2021.
Median age was 85 years, and remained unchanged over time. The mean logistic EuroSCORE gradually decreased over time (28% before 2009 vs 15% for 2009-2014 vs 11% since 2014; P<0.001). Predilatation was performed almost systematically before 2009 (93%), but was rarely performed in the last period (14%; P<0.001). Thirty-day all-cause mortality decreased over time, and was only 1.4% in 2021. Length of stay decreased considerably, with a median duration of only 2 days after the procedure, and>70% of patients were discharged home within 72hours. Similarly, procedural duration, X-ray time and contrast volume decreased over time.
Transfemoral aortic valve implantation, performed as a minimalist "stent-like" procedure using only local anaesthesia, is feasible in the vast majority of patients, with excellent outcomes.
自 2002 年 4 月首例经导管主动脉瓣植入术在鲁昂实施以来，该手术已在全球范围内得到推广。在我们中心，所有经股动脉入路的手术均采用局部麻醉进行，无需经食管超声心动图监测。
报告我们在过去 20 年中使用局部麻醉进行经股动脉经导管主动脉瓣植入术（TAVI）的经验，该经验与器械、实践和适应证的发展有关。
2002 年至 2021 年期间，我们中心共有 2097 例连续患者接受了 TAVI 手术。其中，1780 例行经股动脉主动脉瓣植入术，根据时间分为三组：2009 年前；2009-2014 年；2014-2021 年。
中位年龄为 85 岁，且随时间推移保持不变。平均 logistic EuroSCORE 逐渐降低（2009 年前为 28%，2009-2014 年为 15%，2014 年后为 11%；P<0.001）。2009 年前几乎都进行预扩张（93%），但在最近一段时间很少进行（14%；P<0.001）。30 天全因死亡率随时间推移而降低，2021 年仅为 1.4%。住院时间显著缩短，术后仅 2 天，72 小时内出院的患者>70%。类似地，手术时间、X 线时间和造影剂用量随时间推移而减少。
经股动脉主动脉瓣植入术作为一种微创的“支架样”手术，仅使用局部麻醉即可完成，在绝大多数患者中是可行的，且结果良好。
