Aldalati Omar, Jackson Matthew, Vijayan Seth, Telyuk Pyotr, Hayat Umair, Bashir Shaza, Vahabi Sharareh, McCalmont Gemma, de Belder Mark A, Muir Douglas, Williams Paul D
Cardiothoracic Department, The James Cook University Hospital, Middlesbrough, UK.
Cardiothoracic Directorate, University Hospital of Wales, Cardiff, UK.
Cardiology. 2024;149(5):487-494. doi: 10.1159/000538521. Epub 2024 Mar 25.
The role of balloon aortic valvuloplasty (BAV) in the era of transcatheter aortic valve replacement remains a topic of debate. We sought to study the safety and feasibility of combined BAV and percutaneous coronary intervention (BAV-PCI).
Between November 2009 and July 2020, all patients undergoing BAV were identified and divided into three groups: combined BAV-PCI (group A), BAV with significant unrevascularised CAD (group B), and BAV without significant CAD (group C). Procedural outcomes and 30-day and one-year mortality were compared.
A total of 264 patients were studied (n = 84, 93, and 87 patients in groups A, B, and C, respectively). The STS score was 10.2 ± 8, 13.3 ± 19, and 8.1 ± 7, p = 0.026, in groups A, B, and C, respectively. VARC-3 adjudicated complications were similar among groups (11%, 13%, and 5%, respectively, p = 0.168, respectively). Thirty-day and one-year mortality were 9.8% (n = 26) and 32% (n = 86) of the entire cohort. The differences among groups did not reach statistical significance. Using univariate Cox regression analysis, group B patients were at higher risk of dying compared to group A patients (HR 1.58, 95% CI: 1.11-2.25, p = 0.010). With multivariate Cox regression analysis, the predictors of mortality were STS score, cardiogenic shock, mode of presentation, and lack of subsequent definitive valve intervention.
In high-risk patients with aortic valve stenosis, combined BAV-PCI is safe and feasible with comparable outcomes to BAV with and without significant CAD.
在经导管主动脉瓣置换时代，球囊主动脉瓣成形术（BAV）的作用仍是一个有争议的话题。我们旨在研究BAV联合经皮冠状动脉介入治疗（BAV-PCI）的安全性和可行性。
2009年11月至2020年7月期间，对所有接受BAV的患者进行识别并分为三组：BAV联合PCI（A组）、合并严重未血运重建冠心病的BAV（B组）和无严重冠心病的BAV（C组）。比较手术结果以及30天和1年死亡率。
共研究了264例患者（A、B、C组分别为84、93和87例患者）。A、B、C组的胸外科医师协会（STS）评分分别为10.2±8、13.3±19和8.1±7，p = 0.026。瓣膜学术研究联盟-3（VARC-3）判定的并发症在各组之间相似（分别为11%、13%和5%，p = 0.168）。整个队列的30天和1年死亡率分别为9.8%（n = 26）和32%（n = 86）。各组之间的差异未达到统计学意义。使用单因素Cox回归分析，与A组患者相比，B组患者死亡风险更高（风险比1.58，95%置信区间：1.11-2.25，p = 0.010）。多因素Cox回归分析显示，死亡率的预测因素为STS评分、心源性休克、临床表现方式以及缺乏后续确定性瓣膜干预。
在高危主动脉瓣狭窄患者中，BAV-PCI联合治疗安全可行，其结果与合并或不合并严重冠心病的BAV相当。
