经腋入路与经股入路作为 TAVI 中的默认入路：倾向匹配分析。

Transaxillary versus transfemoral access as default access in TAVI: A propensity matched analysis.

机构信息

Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands.

Amsterdam UMC, University of Amsterdam, Heart Center; Department of Cardiology, Amsterdam Cardiovascular Sciences, Meibergdreef 9, Amsterdam, the Netherlands.

出版信息

Int J Cardiol. 2024 Jan 1;394:131353. doi: 10.1016/j.ijcard.2023.131353. Epub 2023 Sep 9.

DOI:10.1016/j.ijcard.2023.131353

PMID:37696359

Abstract

BACKGROUND

Transfemoral (TF) access is default in transcatheter aortic valve implantation (TAVI). Transaxillary (TAx) access has been shown to be a safe alternative in case of prohibitive iliofemoral anatomy, but whether TAx as preferred access has similar safety and efficacy as TF access is unknown. The aim of this study was to compare outcomes between patients treated with self-expanding devices using TF or TAx route as preferred access in TAVI.

METHODS

A single center cohort of 354 patients treated using TAx as preferred access and a multi-center cohort of 5980 patients treated using TF access were compared. Propensity score matching was used to reduce selection bias and potential confounding. After propensity score matching, each group consisted of 322 patients. Clinical outcomes according to VARC-2 were compared using chi-square test.

RESULTS

In 6334 patients undergoing TAVI, mean age was 81.4 ± 7.0 years, 57% was female and median logistic EuroSCORE was 14.7% (IQR 9.5-22.6). In the matched population (age 79.3 ± 7.0, 50% female, logistic EuroSCORE 13.4%, IQR 9.0-21.5), primary outcomes 30-day and one-year all-cause mortality were similar between Tax and TF groups (30 days: 5% versus 6%, p = 0.90; 1 year: 20% versus 16%, p = 0.17). Myocardial infarction was more frequent in patients undergoing Tax TAVI compared with TF (4% versus 1%, p = 0.05), but new permanent pacemakers were less frequently implanted (12% versus 21%, p = 0.001).

CONCLUSION

TAx as preferred access is feasible and safe with outcomes that are comparable to TF access.

摘要

背景

经股（TF）入路是经导管主动脉瓣植入术（TAVI）的默认入路。经腋（TAx）入路在髂股动脉解剖结构不可行时已被证明是一种安全的替代方法，但 TAx 作为首选入路是否具有与 TF 入路相同的安全性和疗效尚不清楚。本研究旨在比较使用 TF 或 TAx 作为首选入路治疗的患者在 TAVI 中的结局。

方法

将 354 例使用 TAx 作为首选入路治疗的单中心队列和 5980 例使用 TF 入路治疗的多中心队列进行比较。使用倾向评分匹配来减少选择偏倚和潜在的混杂因素。倾向评分匹配后，每组各有 322 例患者。使用卡方检验比较根据 VARC-2 评估的临床结局。

结果

在 6334 例接受 TAVI 的患者中，平均年龄为 81.4 ± 7.0 岁，57%为女性，中位 logistic EuroSCORE 为 14.7%（IQR 9.5-22.6）。在匹配人群（年龄 79.3 ± 7.0，50%为女性，logistic EuroSCORE 为 13.4%，IQR 9.0-21.5）中，TAx 和 TF 组 30 天和 1 年全因死亡率相似（30 天：5%比 6%，p=0.90；1 年：20%比 16%，p=0.17）。与 TF 组相比，TAx TAVI 患者心肌梗死更为常见（4%比 1%，p=0.05），但新植入永久性起搏器的比例较低（12%比 21%，p=0.001）。