Shimahara Yusuke, Fukushima Satsuki, Kanzaki Hideaki, Asaumi Yasuhide, Amaki Makoto, Kawamoto Naonori, Kainuma Satoshi, Tadokoro Naoki, Kakuta Takashi, Takagi Kensuke, Nakai Michikazu, Kobayashi Junjiro, Fujita Tomoyuki
Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan; Department of Cardiovascular Surgery, Tokyo Medical University, Tokyo, Japan.
Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan.
Heart Lung Circ. 2022 Dec;31(12):1666-1676. doi: 10.1016/j.hlc.2022.07.018. Epub 2022 Sep 21.
This study aimed to evaluate the early and intermediate-term outcomes of patients who underwent concomitant off-pump coronary artery bypass grafting (CABG) and transcatheter aortic valve replacement (TAVR).
Between January 2014 and June 2021, 49 patients underwent concomitant off-pump CABG and TAVR via median sternotomy (TAVRCAB group) and 143 underwent concomitant on-pump CABG and surgical aortic replacement. Of the 143 patients who underwent on-pump surgery, 80 (SAVRCAB group) were eligible for comparison. The composite event included all-cause death, heart failure rehospitalisation, repeat revascularisation, brain infarction, and repeat aortic valve replacement.
The Society of Thoracic Surgeons' predicted risk for mortality and age were higher in the TAVRCAB group than in the SAVRCAB group (7.1% vs 3.1% [p<0.001]; 81 yrs vs 75 years [p<0.001], respectively), while the surgical time was shorter (289 min vs 352 min; p<0.001). There was no conversion to on-pump surgery in the TAVRCAB group. The postoperative maximum creatinine kinase-MB value was lower in the TAVRCAB group. There was no deep sternal wound infection or repeat revascularisation in either group. Hospital death and brain infarction developed in one patient (1.3%) each in the SAVRCAB group, but in no patients in the TAVRCAB group. The rates of freedom from the composite event were similar between the two groups during the follow-up period.
Concomitant off-pump CABG and TAVR would be a less-invasive alternative procedure for treating intermediate or high surgical risk patients with aortic stenosis and coronary artery disease unsuitable for percutaneous coronary intervention.
本研究旨在评估同期非体外循环冠状动脉旁路移植术（CABG）和经导管主动脉瓣置换术（TAVR）患者的早期和中期结局。
2014年1月至2021年6月期间，49例患者经正中胸骨切开术同期行非体外循环CABG和TAVR（TAVRCAB组），143例患者同期行体外循环CABG和手术主动脉瓣置换术。在143例行体外循环手术的患者中，80例（SAVRCAB组）符合比较条件。复合事件包括全因死亡、心力衰竭再住院、再次血运重建、脑梗死和再次主动脉瓣置换。
胸外科医师协会预测的TAVRCAB组死亡率和年龄风险高于SAVRCAB组（分别为7.1%对3.1%[p<0.001]；81岁对75岁[p<0.001]），而手术时间更短（289分钟对352分钟；p<0.001）。TAVRCAB组无转为体外循环手术的情况。TAVRCAB组术后肌酸激酶-MB最大值较低。两组均无深部胸骨伤口感染或再次血运重建。SAVRCAB组各有1例患者（1.3%）发生医院死亡和脑梗死，但TAVRCAB组无患者发生。随访期间两组复合事件的无事件发生率相似。
同期非体外循环CABG和TAVR对于治疗不适合经皮冠状动脉介入治疗的主动脉瓣狭窄和冠状动脉疾病的中高危手术患者而言，是一种侵入性较小的替代手术。
