Unità Operativa di Interventistica Cardiovascolare, Pineta Grande Hospital, Castel Volturno, Italy.
Unità Operativa di Emodinamica, Santa Lucia Hospital, San Giuseppe Vesuviano, Italy.
Clin Res Cardiol. 2024 Jan;113(1):68-74. doi: 10.1007/s00392-023-02239-8. Epub 2023 Jun 9.
Transcatheter aortic valve implantation (TAVI) is a mainstay in the management of severe aortic stenosis in patients with intermediate to prohibitive surgical risk. When a single TAVI device fails and cannot be retrieved, TAVI-in-TAVI must be performed acutely, but outcomes of bailout TAVI-in-TAVI have been incompletely appraised. We aimed at analyzing patient, procedural and outcome features of patients undergoing bailout TAVI-in-TAVI in a multicenter registry.
Details of patients undergoing bailout TAVI-in-TAVI, performed acutely or within 24 h of index TAVI, in 6 international high-volume institutions, were collected. For every case provided, 2 same-week consecutive controls (prior TAVI, and subsequent TAVI) were provided. Outcomes of interest were procedural and long-term events, including death, myocardial infarction, stroke, access site complication, major bleeding, and reintervention, and their composite (i.e. major adverse events [MAE]).
A total of 106 patients undergoing bailout TAVI-in-TAVI were included, as well as 212 controls, for a total of 318 individuals. Bailout TAVI-in-TAVI was less common in younger patients, those with higher body mass index, or treated with Portico/Navitor or Sapien devices (all p < 0.05). Bailout TAVI-in-TAVI was associated with higher in-hospital rates of death, emergency surgery, MAE, and permanent pacemaker implantation (all p < 0.05). Long-term follow-up showed that bailout TAVI-in-TAVI was associated with higher rates of death and MAE (both < 0.05). Similar findings were obtained at adjusted analyses (all p < 0.05). However, censoring early events, outlook was not significantly different when comparing the two groups (p = 0.897 for death, and p = 0.645 for MAE).
Bail-out TAVI-in-TAVI is associated with significant early and long-term mortality and morbidity. Thus, meticulous preprocedural planning and sophisticated intraprocedural techniques are of paramount importance to avoid these emergency procedures.
经导管主动脉瓣置换术（TAVI）是治疗中高危外科手术风险严重主动脉瓣狭窄患者的主要方法。当单个 TAVI 装置失败且无法取出时，必须立即进行 TAVI 内 TAVI，但尚未完全评估紧急 TAVI 内 TAVI 的转归。我们旨在分析多中心注册中心中接受紧急 TAVI 内 TAVI 的患者的患者、手术和结局特征。
收集了 6 家国际高容量机构中接受紧急 TAVI 内 TAVI 的患者的详细信息，这些患者是在指数 TAVI 后立即或 24 小时内进行的。对于提供的每个病例，均提供了 2 个相同周的连续对照（之前的 TAVI 和随后的 TAVI）。关注的结局包括手术和长期事件，包括死亡、心肌梗死、卒中和入路部位并发症、大出血和再次介入，以及它们的复合（即主要不良事件 [MAE]）。
共纳入 106 例接受紧急 TAVI 内 TAVI 的患者，以及 212 例对照，共 318 人。在年轻患者、体重指数较高或接受 Portico/Navitor 或 Sapien 装置治疗的患者中，紧急 TAVI 内 TAVI 较少见（均 < 0.05）。紧急 TAVI 内 TAVI 与住院期间更高的死亡率、急诊手术、MAE 和永久性起搏器植入率相关（均 < 0.05）。长期随访显示，紧急 TAVI 内 TAVI 与更高的死亡率和 MAE 相关（均 < 0.05）。在调整分析中也得到了类似的发现（均 < 0.05）。然而，当比较两组时，早期事件的截止后预后并无显著差异（死亡的 p 值=0.897，MAE 的 p 值=0.645）。
紧急 TAVI 内 TAVI 与显著的早期和长期死亡率和发病率相关。因此，术前精心规划和术中复杂技术至关重要，以避免这些紧急手术。
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