Department of Cardiology, University Hospital Frankfurt am Main, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany.
German Center for Cardiovascular Research, DZHK, Partner Site Rhine-Main, Rhine-Main, Germany.
Clin Res Cardiol. 2022 Dec;111(12):1387-1395. doi: 10.1007/s00392-022-02083-2. Epub 2022 Sep 8.
We compared TAVI vs. SAVR in patients with moderate-to-severe chronic kidney disease (eGFR 15-60 ml/min/1.73 m) for whom both procedures could possibly be considered (age ≤ 80 years, STS-score 4-8).
According to both ACC/AHA and ESC/EACTS recent guidelines, aortic stenosis may be treated with either transcatheter (TAVI) or surgical (SAVR) aortic valve replacement in a subgroup of patients. A shared therapeutic decision is made by a heart team based on individual factors, including chronic kidney disease (CKD).
Data from the large nationwide German Aortic Valve Registry were used. A propensity score method was used to select 704 TAVI and 374 SAVR matched patients. Primary endpoint was 1-year survival. Secondary endpoints were clinical complications, including pacemaker implantation, vascular complications, myocardial infarction, bleeding, and the need for new-onset dialysis.
One-year survival was similar (HR [95% CI] for TAVI 1.271 [0.795, 2.031], p = 0.316), with no divergence in Kaplan-Meier curves. In spite of post-procedural short-term survival being numerically higher for TAVI patients and 1-year survival being numerically higher for SAVR patients, such differences did not reach statistical significance (96.4% vs. 94.2%, p = 0.199, and 86.2% vs. 81.2%, p = 0.316, respectively). In weighted analyses, pacemaker implantation, vascular complications, and were significantly more common with TAVI; whereas myocardial infarction, bleeding requiring transfusion, and longer ICU-stay and overall hospitalization were higher with SAVR. Temporary dialysis was more common with SAVR (p < 0.0001); however, a probable need for chronic dialysis was rare and similar in both groups.
Both TAVI and SAVR led to comparable and excellent results in patients with moderate-to-severe CKD in an intermediate-risk population of patients with symptomatic severe aortic stenosis for whom both therapies could possibly be considered.
我们比较了经导管主动脉瓣置换术（TAVI）与外科主动脉瓣置换术（SAVR）在中重度慢性肾脏病（eGFR 15-60 ml/min/1.73 m）患者中的疗效，这些患者两种治疗方法均可能适用（年龄≤80 岁，STS 评分 4-8）。
根据 ACC/AHA 和 ESC/EACTS 最近的指南，在亚组患者中，主动脉瓣狭窄可以通过经导管（TAVI）或外科（SAVR）主动脉瓣置换术进行治疗。心脏团队根据个体因素（包括慢性肾脏病（CKD））做出共同的治疗决策。
利用来自德国大型全国性主动脉瓣登记处的数据。采用倾向评分法选择了 704 例 TAVI 和 374 例 SAVR 匹配患者。主要终点为 1 年生存率。次要终点包括临床并发症，包括起搏器植入、血管并发症、心肌梗死、出血和需要新出现的透析。
1 年生存率相似（TAVI 的 HR [95%CI]为 1.271 [0.795，2.031]，p=0.316），Kaplan-Meier 曲线无差异。尽管 TAVI 患者术后短期生存率在数值上更高，SAVR 患者 1 年生存率在数值上更高，但这些差异没有统计学意义（96.4%比 94.2%，p=0.199，86.2%比 81.2%，p=0.316）。在加权分析中，TAVI 更常见起搏器植入、血管并发症，而 SAVR 更常见心肌梗死、需要输血的出血和更长的 ICU 住院时间和总住院时间。SAVR 更常见临时透析（p<0.0001）；然而，两组均需要慢性透析的可能性都很低。
在中危患者中，对于有症状的重度主动脉瓣狭窄、两种治疗方法均可能适用的中重度 CKD 患者，TAVI 和 SAVR 均能带来相当优异的结果。
