D'Arcy Sutherland Cardiothoracic Surgical Unit, Royal Adelaide Hospital, Adelaide, SA, Australia.
D'Arcy Sutherland Cardiothoracic Surgical Unit, Royal Adelaide Hospital, Adelaide, SA, Australia.
Heart Lung Circ. 2022 Aug;31(8):1153-1165. doi: 10.1016/j.hlc.2022.04.047. Epub 2022 May 14.
Since the last formal publication reporting on the findings of the Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) database on surgical aortic valve replacement (SAVR) and transcatheter aortic valve replacement (TAVR) in 2016, transcatheter approaches have become common practice. There has been an increase in use of TAVR following large, randomised control trials that only report on short-term outcomes in a selective cohort. This study aims to report on primary outcome measures and identify complications associated with SAVR and TAVR from a large national database.
From the ANZSCTS database (2001-19), 14,097 SAVR and 1,194 TAVR patients were identified with clinical details and 30-day follow-up available. The primary endpoint was the composite of all-cause mortality and/or permanent stroke at 30 days. Secondary endpoints were post-procedure complications requiring treatment. Logistical regression followed by propensity score matching was performed.
Using logistical regression when all patient factors considered for all patients who had SAVR and TAVR, the only preoperative factors that had an impact on 30-day mortality was cerebrovascular disease, respiratory disease, preoperative dialysis, angina, and hypertension. Primary outcome 30-day mortality rate was 1.83% in the SAVR group, and 1.68% in patients in the TAVR group, p=0.7001, and permanent stroke was seen in 1.07% patients in the SAVR group, and 1.26% patients in the TAVR group. Acute limb ischaemia, aortic dissection, ventricular tachycardia, bradyarrhythmia and heart block were more common following TAVR (p<0.001), while reintubation and atrial arrhythmia were more common following SAVR (p<0.001).
In the real world SAVR and TAVR have been used in very different patient groups and it is difficult to compare as different baseline characteristics and complications. The two patient groups maintain similarities in primary and secondary endpoints, but differences in life threatening and life altering morbidity remains significant. Collection of SAVR and TAVR data in a combined database may help to better capture and compare these complications and institute strategies to prevent them.
自 2016 年澳大利亚和新西兰心脏和胸外科医师学会（ANZSCTS）数据库报告关于主动脉瓣置换术（SAVR）和经导管主动脉瓣置换术（TAVR）的研究结果以来，经导管治疗方法已成为常规治疗手段。随着仅报告在选择性队列中短期结果的大型随机对照试验的开展，TAVR 的应用有所增加。本研究旨在报告大型国家数据库中 SAVR 和 TAVR 的主要结果测量指标，并确定相关并发症。
从 ANZSCTS 数据库（2001-19 年）中，确定了 14097 例 SAVR 和 1194 例 TAVR 患者，具有临床细节和 30 天随访资料。主要终点是 30 天内全因死亡率和/或永久性中风的复合终点。次要终点是需要治疗的术后并发症。采用逻辑回归，然后进行倾向评分匹配。
在对接受 SAVR 和 TAVR 的所有患者进行所有考虑的患者因素的逻辑回归中，唯一对 30 天死亡率有影响的术前因素是脑血管疾病、呼吸疾病、术前透析、心绞痛和高血压。SAVR 组的主要结局 30 天死亡率为 1.83%，TAVR 组为 1.68%，p=0.7001，SAVR 组永久性中风发生率为 1.07%，TAVR 组为 1.26%。TAVR 后急性肢体缺血、主动脉夹层、室性心动过速、缓心律失常和心脏传导阻滞更为常见（p<0.001），而 SAVR 后再插管和房性心律失常更为常见（p<0.001）。
在真实世界中，SAVR 和 TAVR 已用于非常不同的患者群体，由于基线特征和并发症不同，因此很难进行比较。两组患者在主要和次要终点方面保持相似，但危及生命和改变生活的发病率仍存在显著差异。将 SAVR 和 TAVR 数据收集在一个联合数据库中可能有助于更好地捕获和比较这些并发症，并制定预防这些并发症的策略。
