85岁及以上患者与85岁及以下患者经导管主动脉瓣置换术的结果
Outcome of transcatheter aortic valve replacement in patients over 85 years of age versus patients aged 85 and younger.
作者信息
van den Brink F S, Wijtsma I, Amrane H, Vossenberg T N E, Haenen J, Porta F, Van Boven A J, Hofma S H
机构信息
Department of Cardiology, Medical Centre Leeuwarden (MCL), Leeuwarden, The Netherlands.
Department of Anaesthesiology, Medical Centre Leeuwarden (MCL), Leeuwarden, The Netherlands.
出版信息
Neth Heart J. 2022 Oct;30(10):473-478. doi: 10.1007/s12471-022-01693-9. Epub 2022 May 24.
INTRODUCTION
The Dutch general population is aging rapidly. Many of these patient are fit and eligible for TAVR. However, studies on outcome in older versus younger patients are scant.
MATERIAL AND METHODS
A single-centre retrospective study comparing patients older and younger than age 85 on outcome.
RESULTS
190 patients underwent TAVR: 136 were aged 85 or younger (U85), 54 were older than 85 (O85). The U85 group had more men (U85: 71 [52.2%] vs O85: 19 [35.2%]; p = 0.034), a higher incidence of diabetes (U85: 36 [26.5%] vs O85: 3 [5.6%]; p = 0.001) and atrial fibrillation (U85: 35 [25.7%] vs O85: 5 [9.3%]; p = 0.03) and a higher body mass index (U85: 27.5 [± 5.24] vs O85: 26 [± 3.78]; p = 0.027). In the O85 group there was a lower estimated glomerular filtration rate (O85: 50.28 [± 15.32] ml/min vs U85: 65.25 [± 29.97] ml/min; p = 0.012). There was no difference in 30-day mortality (U85: 6 [4.4%] vs O85: 3 [5.6%]) and 1‑year mortality (U85 9 [6.6%] vs O85 3 [5.6%]) (p = 0.521). There was an equal amount of new onset permanent left bundle branch block (U85: 38 [27.9%] vs O85: 14 [25.9%]; p = 0.896) and permanent pacemaker implantation (U85: 28 [20.6%] vs O85: 28 [20.6%]; p = 0.748). There was no difference in bleeding events (p = 0.469), vascular complications (p = 0.195) or moderate/severe regurgitation (p = 0.972). The U85 group had a slightly longer admission duration (U85 6.29 [± 5.289] days vs O85 5.98 [± 3.328] days (p = 0.037)).
CONCLUSION
TAVR in patients over 85 years of age has excellent outcome, comparable to those aged 85 and younger.
引言
荷兰普通人群正在迅速老龄化。这些患者中有许多身体状况良好，适合接受经导管主动脉瓣置换术（TAVR）。然而，关于老年患者与年轻患者手术结果的研究却很少。
材料与方法
一项单中心回顾性研究，比较年龄在85岁及以下和85岁以上患者的手术结果。
结果
190例患者接受了TAVR：136例年龄在85岁及以下（U85组），54例年龄大于85岁（O85组）。U85组男性更多（U85组：71例[52.2%] vs O85组：19例[35.2%]；p = 0.034），糖尿病发病率更高（U85组：36例[26.5%] vs O85组：3例[5.6%]；p = 0.001），心房颤动发病率更高（U85组：35例[25.7%] vs O85组：5例[9.3%]；p = 0.03），体重指数更高（U85组：27.5[±5.24] vs O85组：26[±3.78]；p = 0.027）。O85组的估计肾小球滤过率较低（O85组：50.28[±15.32]ml/分钟 vs U85组：65.25[±29.97]ml/分钟；p = 0.012）。30天死亡率（U85组：6例[4.4%] vs O85组：3例[5.6%]）和1年死亡率（U85组9例[6.6%] vs O85组3例[5.6%]）无差异（p = 0.521）。新发永久性左束支传导阻滞（U85组：38例[27.9%] vs O85组：14例[25.9%]；p = 0.896）和永久性起搏器植入（U85组：28例[20.6%] vs O85组：28例[20.6%]；p = 0.748）的数量相等。出血事件（p = 0.469）、血管并发症（p = 0.195）或中度/重度反流（p = 0.972）无差异。U85组的住院时间略长（U85组6.29[±5.289]天 vs O85组5.98[±3.328]天（p = 0.037））。
结论
85岁以上患者接受TAVR的手术结果优异，与85岁及以下患者相当。
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