Zubarevich Alina, Szczechowicz Marcin, Amanov Lukman, Arjomandi Rad Arian, Osswald Anja, Torabi Saeed, Ruhparwar Arjang, Weymann Alexander
Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University of Duisburg-Essen, 45117 Essen, Germany.
Department of Medicine, Faculty of Medicine, Imperial College London, London SW7 2AZ, UK.
Life (Basel). 2022 Jun 29;12(7):979. doi: 10.3390/life12070979.
The rapid development of transcatheter treatment methods has made transcatheter aortic valve replacement (TAVR) a feasible alternative to conventional surgical aortic valve replacement (SAVR). Recently, indications for TAVR have been expanded to intermediate- and low-risk patients, although there still remains a portion of ineligible patients. We sought to evaluate and compare our experience with sutureless SAVR and transapical TAVR in the "grey-area" of patients unsuitable for transfemoral access.
Between April 2018 and June 2021, 248 consecutive patients underwent a sutureless SAVR (SU-SAVR) or TA-TAVR at our institution. We performed a pair-matched analysis and identified 56 patient pairs based on the EuroSCORE II. All transcatheter procedures were performed using SAPIEN XT/3™ prostheses, while all surgical procedures deployed the Perceval (LivaNova) aortic valve.
All patients presented with multiple comorbidities as reflected by the median EuroSCORE-II of 3.1% (IQR 1.9-5.3). Thirty-four patients from the surgical group (60.7%) underwent a concomitant myocardial revascularization. There was no significant difference in major adverse events, pacemaker implantation or postoperative mortality during follow-up. Both interventions demonstrated technical success with similar mean postoperative pressure gradients at follow-up and no cases of paravalvular leakage.
Sutureless aortic valve replacement constitutes a feasible treatment alternative for patients with aortic valve disease who are ineligible for transfemoral access route and/or require concomitant coronary revascularization. With its excellent hemodynamic performance, similar survival compared to TA-TAVR, and high cost-efficiency without compromising the postoperative outcomes and in-hospital length of stay SU-AVR might be considered for patients in the "grey-area" between TAVR and SAVR.
经导管治疗方法的迅速发展使经导管主动脉瓣置换术（TAVR）成为传统外科主动脉瓣置换术（SAVR）的一种可行替代方案。最近，TAVR的适应证已扩大到中低风险患者，尽管仍有一部分患者不符合条件。我们试图评估并比较在不适合经股动脉入路的“灰色区域”患者中，我们进行无缝合SAVR和经心尖TAVR的经验。
2018年4月至2021年6月期间，248例连续患者在我们机构接受了无缝合SAVR（SU-SAVR）或经心尖TAVR。我们进行了配对分析，并根据欧洲心脏手术风险评估系统II（EuroSCORE II）确定了56对患者。所有经导管手术均使用SAPIEN XT/3™ 人工瓣膜，而所有外科手术均植入Perceval（LivaNova）主动脉瓣。
所有患者均有多种合并症，欧洲心脏手术风险评估系统II中位数为3.1%（四分位间距1.9 - 5.3）。手术组34例患者（60.7%）同时进行了心肌血运重建。随访期间，主要不良事件、起搏器植入或术后死亡率无显著差异。两种干预措施均显示技术成功，随访时平均术后压力阶差相似，且无瓣周漏病例。
对于不适合经股动脉入路和/或需要同时进行冠状动脉血运重建的主动脉瓣疾病患者，无缝合主动脉瓣置换术是一种可行的治疗选择。由于其优异的血流动力学性能、与经心尖TAVR相似的生存率以及高成本效益，且不影响术后结果和住院时间，对于处于TAVR和SAVR之间“灰色区域”的患者，可考虑采用无缝合主动脉瓣置换术。
