经心尖经导管主动脉瓣置换术：三级中心的真实世界早期和中期结果
Transapical Transcatheter Aortic Valve Replacement: A Real-World Early and Mid-Term Outcome of a Third-Level Centre.
作者信息
Francica Alessandra, Tonelli Filippo, Saran Alberto, Pesarini Gabriele, Vendramin Igor, Tabbì Rocco, Rossetti Cecilia, Luciani Giovanni Battista, Ribichini Flavio L, Onorati Francesco
机构信息
Department of Surgery, Dentistry, Paediatrics, and Gynaecology, Division of Cardiac Surgery, University of Verona Medical School, 37126 Verona, Italy.
Department of Medicine, Division of Cardiology, University of Verona Medical School, 37126 Verona, Italy.
出版信息
J Clin Med. 2022 Jul 18;11(14):4158. doi: 10.3390/jcm11144158.
BACKGROUND
Transapical transcatheter aortic valve replacement (TA-TAVR) is generally considered to be associated with higher morbidity compared with transfemoral-TAVR. However, TA-TAVR remains a feasible alternative for patients who are unsuitable for TF-TAVR. It has been shown that outcomes after TAVR are linked to the operator's expertise. Therefore, the purpose of this study is to report short- and mid-term outcomes after TA-TAVR performed by an expert Heart-Team of a third-level centre.
METHODS
From 2015 to 2022, 154 consecutive patients underwent TA-TAVR. The outcomes were analysed according to the VARC-3 criteria. Kaplan-Meier curves were estimated for major clinical events at mid-term follow-up.
RESULTS
The mean age of the population was 79.3 years and the STS risk-score of mortality was 4.2 ± 3.6%. Periprocedural mortality was 1.9%. Acute kidney injury and prolonged ventilation occurred in 1.9%. Incidence of stroke was 0.6%. Pacemaker implantation rate was 1.9%. Freedom from cardiovascular mortality was 75.7%, and 60.2% at 3 and 5 years. Freedom from stroke was 92.3% and 88.9% at 3 and 5 years, respectively; freedom from endocarditis was 94.4% and 90.8% at 3 and 5 years, respectively.
CONCLUSION
TA-TAVR may be considered a safe and effective alternative approach in patients unsuitable for TF-TAVR, especially when performed by a proficient Heart-Team.
背景
与经股动脉经导管主动脉瓣置换术（TF-TAVR）相比，经心尖经导管主动脉瓣置换术（TA-TAVR）通常被认为具有更高的发病率。然而，对于不适合TF-TAVR的患者，TA-TAVR仍然是一种可行的替代方案。已经表明，TAVR后的结果与术者的专业技能有关。因此，本研究的目的是报告由三级中心的专业心脏团队进行TA-TAVR后的短期和中期结果。
方法
2015年至2022年，154例连续患者接受了TA-TAVR。根据VARC-3标准分析结果。对中期随访时的主要临床事件估计Kaplan-Meier曲线。
结果
患者的平均年龄为79.3岁，STS死亡风险评分为4.2±3.6%。围手术期死亡率为1.9%。急性肾损伤和通气时间延长的发生率为1.9%。卒中发生率为0.6%。起搏器植入率为1.9%。3年和5年时心血管死亡率的无事件生存率分别为75.7%和60.2%。3年和5年时卒中的无事件生存率分别为92.3%和88.9%；3年和5年时心内膜炎的无事件生存率分别为94.4%和90.8%。
结论
对于不适合TF-TAVR的患者，TA-TAVR可被视为一种安全有效的替代方法，尤其是由熟练的心脏团队进行时。
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