根据左心室射血分数分层的经导管主动脉瓣置换术的临床结果：一项单中心试点研究。
Clinical outcomes of transcatheter aortic valve replacement stratified by left ventricular ejection fraction: A single centre pilot study.
作者信息
Al Balool Joud, Al Jarallah Mohammed, Rajan Rajesh, Dashti Raja, Alasousi Nader, Kotevski Vladimir, Taha Mousa Ahmed Said, Al Haroun Retaj, Tse Gary, Zhanna Kobalava D, Setiya Parul, Saber Ahmad Al, Brady Peter A
机构信息
Department of Medicine, Faculty of Medicine, Kuwait University, Jabriya, Kuwait.
Department of Cardiology, Sabah Al Ahmed Cardiac Centre, Al Amiri Hospital, Kuwait City, Kuwait.
出版信息
Ann Med Surg (Lond). 2022 May 7;77:103712. doi: 10.1016/j.amsu.2022.103712. eCollection 2022 May.
INTRODUCTION
To define baseline echocardiographic, electrocardiographic (ECG) and computed tomographic (CT) findings of patients with heart failure undergoing transcatheter aortic valve replacement (TAVR) and analyze their overall procedural outcomes.
METHODS
Between 2018 and 2021, patients with severe aortic stenosis (AS) who performed transcatheter aortic valve replacement (TAVR) in Sabah Al Ahmad Cardiac Centre, Al Amiri Hospital were identified. A retrospective review of patients' parameters including pre-, intra-, and post-procedural data was conducted. Patients were grouped in 2 subgroups according to their EF: EF <40% (HFrEF) and EF ≥ 40%. The data included patients' baseline characteristics, electrocardiographic and echocardiographic details along with pre-procedural CT assessment of aortic valve dimensions. Primary outcomes including post-operative disturbances, pacemaker implantation and in-hospital mortality following TAVR were additionally analyzed.
RESULTS
A total of 61 patients with severe AS underwent TAVR. The mean age was 73.5 ± 9, and 21 (34%) of the patients were males. The mean ejection fraction (EF) was 55.5 ± 9.7%. Of 61 patients, 12 (20%) were identified as heart failure with reduced EF (<40%). These patients were younger, more often males, and were more likely to have coronary artery disease (75% versus 53.1%). Left ventricular hypertrophy and diastolic dysfunction was documented in 75% and 58.3% of patients with heart failure with reduced ejection fraction (HFrEF) respectively. Post TAVR conduction disturbances, with the commonest being LBBB was observed in 41.7%. Permanent pacemaker was implanted in 3 of patients with HFrEF (25%). There were no significant differences between the two groups with regards to in hospital mortality (p = 0.618).
CONCLUSION
Severe AS with EF <40% constitute a remarkable proportion of patients undergoing TAVR. Preliminary results of post-operative conduction disturbances and in hospital mortality in HFrEF patients were concluded to not differ from patients with LVEF ≥40%.
引言
明确接受经导管主动脉瓣置换术（TAVR）的心力衰竭患者的基线超声心动图、心电图（ECG）和计算机断层扫描（CT）检查结果，并分析其总体手术结局。
方法
2018年至2021年期间，在阿米里医院萨巴赫·艾哈迈德心脏中心接受经导管主动脉瓣置换术（TAVR）的重度主动脉瓣狭窄（AS）患者被纳入研究。对患者的参数进行回顾性分析，包括术前、术中和术后数据。根据射血分数（EF）将患者分为两个亚组：EF<40%（射血分数降低的心力衰竭，HFrEF）和EF≥40%。数据包括患者的基线特征、心电图和超声心动图细节，以及术前主动脉瓣尺寸的CT评估。还额外分析了主要结局，包括术后心律失常、起搏器植入和TAVR术后的院内死亡率。
结果
共有61例重度AS患者接受了TAVR。平均年龄为73.5±9岁，21例（34%）患者为男性。平均射血分数（EF）为55.5±9.7%。在61例患者中，12例（20%）被确定为射血分数降低的心力衰竭（<40%）。这些患者更年轻，男性更多，且更有可能患有冠状动脉疾病（75%对53.1%）。射血分数降低的心力衰竭（HFrEF）患者中，分别有75%和58.3%记录有左心室肥厚和舒张功能障碍。TAVR术后心律失常中，最常见的是左束支传导阻滞，发生率为41.7%。3例HFrEF患者（25%）植入了永久性起搏器。两组在院内死亡率方面无显著差异（p=0.618）。
结论
射血分数<40%的重度AS患者在接受TAVR的患者中占相当比例。得出结论，HFrEF患者术后心律失常和院内死亡率的初步结果与左心室射血分数≥40%的患者无差异。
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