Høydahl Martin Petter, Busund Rolf, Rösner Assami, Kjønås Didrik
Clinical Cardiovascular Research Group, Institute of Clinical Medicine, The Arctic University of Norway, Tromsø, Norway.
Department of Cardiothoracic Surgery, University Hospital of North Norway, Tromsø, Norway.
Front Cardiovasc Med. 2024 Jan 15;11:1298346. doi: 10.3389/fcvm.2024.1298346. eCollection 2024.
Treatment of severe aortic stenosis with transcatheter aortic valve implantation (TAVI) was introduced in 2002. Since then, TAVI has become the primary treatment approach worldwide for advanced-age patients and younger patients with severe comorbidities. We aimed to evaluate the changes in patient demographics, complications, and mortality rates within 13 years.
This retrospective observational study included 867 patients who underwent TAVI at the University Hospital of North Norway in Tromsø from 2008 to 2021. The 13-year period was divided into period 1 (2008-2012), period 2 (2013-2017), and period 3 (2018-2021). The primary objective was to evaluate the changes in periprocedural (30 days), early (30-365 days), and late mortality rates (>365 days) between the periods. The secondary objective was to evaluate late mortality rates by sex and age groups: <70 years, 70-79 years, 80-89 years, and ≥90 years.
The periprocedural mortality rates for periods 1, 2, and 3 were 10.3%, 2.9%, and 1.2%, respectively ( < 0.001). The early mortality rates were 5.6%, 5.8%, and 6.5%, respectively. No significant differences were observed in late mortality by sex or age group (<70, 70-79, and 80-89 years) with a median survival of 5.3-5.6 years. The median survival in patients aged ≥90 years was 4.0 years ( = 0.018).
Our findings indicate that most patients are octogenarians, and the burden of their comorbidities should be highly considered compared to their age when evaluating the procedural outcomes. As the incidence of most complications related to TAVI has decreased, the rates of permanent pacemaker implantation remain high. Important advancements in diagnostics, valve technology, and procedural techniques have improved the periprocedural mortality rates; however, early mortality remains unchanged and poses a clinical challenge that needs to be addressed in the future.
经导管主动脉瓣植入术（TAVI）于2002年开始用于治疗严重主动脉瓣狭窄。自那时起，TAVI已成为全球范围内老年患者及合并严重疾病的年轻患者的主要治疗方法。我们旨在评估13年内患者人口统计学特征、并发症及死亡率的变化。
这项回顾性观察性研究纳入了2008年至2021年在挪威特罗姆瑟大学医院接受TAVI治疗的867例患者。13年的时间段分为第1期（2008 - 2012年）、第2期（2013 - 2017年）和第3期（2018 - 2021年）。主要目的是评估各期围手术期（30天）、早期（30 - 365天）和晚期死亡率（>365天）的变化。次要目的是按性别和年龄组评估晚期死亡率：<70岁、70 - 79岁、80 - 89岁和≥90岁。
第1期、第2期和第3期的围手术期死亡率分别为10.3%、2.9%和1.2%（<0.001）。早期死亡率分别为5.6%、5.8%和6.5%。按性别或年龄组（<70岁、70 - 79岁和80 - 89岁）划分的晚期死亡率无显著差异，中位生存期为5.3 - 5.6年。≥90岁患者的中位生存期为4.0年（P = 0.018）。
我们的研究结果表明，大多数患者为八旬老人，在评估手术结果时，与他们的年龄相比，应高度考虑其合并症负担。随着与TAVI相关的大多数并发症发生率下降，永久起搏器植入率仍然很高。诊断、瓣膜技术和手术技术的重要进展改善了围手术期死亡率；然而，早期死亡率保持不变，这是一个未来需要解决的临床挑战。
