Department of Cardiology, Mater Misericordiae University Hospital, Dublin, Ireland.
Department of Cardiology, Mater Private Hospital, Dublin, Ireland.
Open Heart. 2024 Mar 27;11(1):e002610. doi: 10.1136/openhrt-2024-002610.
A paucity of data exists on how transcatheter aortic valve implantation (TAVI) practice has evolved in Ireland. This study sought to analyse temporal trends in patient demographics, procedural characteristics, and clinical outcomes at an Irish tertiary referral centre.
The prospective Mater TAVI database was divided into time tertiles based on when TAVI was performed: Group A, November 2008-April 2013; Group B, April 2013-September 2017; and Group C, September 2017-February 2022. Patient and procedural characteristics and clinical outcomes were compared across groups.
A total of 1063 (Group A, 59; Group B, 268; and Group C:, 736) patients were treated with TAVI during the study period (mean age 81.1±7.4, mean Society of Thoracic Surgeons score 5.9±5.1).Conscious sedation (Group A, 0%; Group B, 59.9%; and Group C, 90.2%, p<0.001) and femoral artery access (Group A, 76.3%; Group B, 90.7%; and Group C, 96.6%, p<0.001) were used more frequently over time. The median length of hospital stay reduced from 9 days (IQR 7, 18) in Group A to 2 days (IQR 2, 3) in Group C. In-hospital death was numerically higher in Group A compared with Group C (6.8% vs 1.9%, p=0.078). At 1-year follow-up, the rate of death and/or stroke was similar in Group A and Group C (20.3% vs 12.0%, adjusted HR 1.49, 95% CI (0.59 to 3.74)).
There was exponential growth in TAVI procedural volume during the study period. A minimalist approach to TAVI emerged, and this was associated with significantly shorter procedure duration and hospital stay. Clinical outcomes at 1-year follow-up did not change significantly over time.
关于经导管主动脉瓣植入术（TAVI）在爱尔兰的实践情况如何演变，相关数据十分匮乏。本研究旨在分析爱尔兰一家三级转诊中心的患者人口统计学、手术特征和临床结局的时间趋势。
前瞻性的 Mater TAVI 数据库根据 TAVI 实施时间分为三个时间组：A 组，2008 年 11 月至 2013 年 4 月；B 组，2013 年 4 月至 2017 年 9 月；C 组，2017 年 9 月至 2022 年 2 月。比较了各组患者和手术特征及临床结局。
研究期间共对 1063 例（A 组 59 例，B 组 268 例，C 组 736 例）患者行 TAVI 治疗（平均年龄 81.1±7.4 岁，平均胸外科医师协会评分 5.9±5.1 分）。镇静（A 组 0%，B 组 59.9%，C 组 90.2%，p<0.001）和股动脉入路（A 组 76.3%，B 组 90.7%，C 组 96.6%，p<0.001）的使用率随时间推移而逐渐增加。中位住院时间从 A 组的 9 天（IQR 7，18）缩短至 C 组的 2 天（IQR 2，3）。A 组住院期间死亡率较 C 组略高（6.8% vs 1.9%，p=0.078）。1 年随访时，A 组和 C 组的死亡率和/或卒中率相似（20.3% vs 12.0%，调整后 HR 1.49，95%CI（0.59 至 3.74））。
研究期间 TAVI 手术量呈指数级增长。TAVI 治疗方法趋于极简，这与手术持续时间和住院时间显著缩短有关。1 年随访时临床结局无明显随时间变化。
