Malvindi Pietro Giorgio, Berretta Paolo, Capestro Filippo, Bifulco Olimpia, Alfonsi Jacopo, Cefarelli Mariano, Pierri Michele Danilo, Di Eusanio Marco
Cardiac Surgery Unit, Lancisi Cardiovascular Center, Polytechnic University of Marche, Ancona, Italy.
Interdiscip Cardiovasc Thorac Surg. 2023 Jun 1;36(6). doi: 10.1093/icvts/ivad074.
Current evidence on transcatheter aortic valve implantation (TAVI) has been generated exclusively by cardiology studies and no operative data from cardiac surgeons are available. Here, we describe the development of our TAVI programme and report the results of transfemoral (TF) TAVI done by cardiac surgeons on their own.
This study included all the TAVI procedures on native valve performed at Cardiac Surgery Unit, Ospedali Riuniti di Ancona, during the period October 2018 to July 2022. Relevant prospectively collected preoperative, intraprocedural and postoperative data were retrieved from the Institutional database.
A total of 413 patients were included in the study. Mean patients' age was 82 years and among them 44% (180/413) were male. STS score was 3.1% (2.2-4.4). Eighty patients underwent transapical TAVI and 333 patients had a TF approach. We progressively moved from transapical TAVI towards TF procedures that are now routinely performed on conscious sedation and using a fully percutaneous approach. After TF TAVI, 30-day mortality rate was 1%, cerebral stroke occurred in 2% of the cases, permanent pacemaker implantation was necessary in 23% of the patients and in 6% of the cases there was a moderate/severe degree of aortic regurgitation. There was no association between operators performing TAVI and 30-day mortality.
The acquisition of catheter-based skills and an adequate training allowed cardiac surgeons to perform on their own awake and fully percutaneous TF TAVI with similar results when compared with major randomized clinical trials and registries' experiences.
目前关于经导管主动脉瓣植入术（TAVI）的证据完全来自心脏病学研究，尚无心脏外科医生的手术数据。在此，我们描述了我们的TAVI项目的发展情况，并报告心脏外科医生自行进行的经股动脉（TF）TAVI的结果。
本研究纳入了2018年10月至2022年7月期间在安科纳联合医院心脏外科进行的所有原生瓣膜TAVI手术。从机构数据库中检索前瞻性收集的相关术前、术中及术后数据。
共413例患者纳入研究。患者平均年龄82岁，其中44%（180/413）为男性。胸外科医师协会（STS）评分3.1%（2.2 - 4.4）。80例患者接受经心尖TAVI，333例患者采用TF入路。我们逐渐从经心尖TAVI转向TF手术，目前TF手术常规在清醒镇静下采用完全经皮入路进行。TF TAVI术后，30天死亡率为1%，2%的病例发生脑卒，23%的患者需要植入永久性起搏器，6%的病例存在中度/重度主动脉瓣反流。进行TAVI的术者与30天死亡率之间无关联。
掌握基于导管的技术并接受充分培训后，心脏外科医生能够自行进行清醒且完全经皮的TF TAVI，与主要随机临床试验和登记研究的经验相比，结果相似。
