经导管心脏瓣膜取出术治疗感染性心内膜炎相关假体失败及结局：EXPLANT-TAVR 国际注册研究。
Transcatheter heart valve explant with infective endocarditis-associated prosthesis failure and outcomes: the EXPLANT-TAVR international registry.
机构信息
University Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany.
Department of Cardiovascular Surgery, Mount Sinai Medical Center, 1190 Fifth Avenue, GP2W, Box 1028, New York, NY 10029, USA.
出版信息
Eur Heart J. 2024 Jul 21;45(28):2519-2532. doi: 10.1093/eurheartj/ehae292.
BACKGROUND AND AIMS
Surgical explantation of transcatheter heart valves (THVs) is rapidly increasing, but there are limited data on patients with THV-associated infective endocarditis (IE). This study aims to assess the outcomes of patients undergoing THV explant for IE.
METHODS
All patients who underwent THV explant between 2011 and 2022 from 44 sites in the EXPLANT-TAVR registry were identified. Patients with IE as the reason for THV explant were compared to those with other mechanisms of bioprosthetic valve dysfunction (BVD).
RESULTS
A total of 372 patients from the EXPLANT-TAVR registry were included. Among them, 184 (49.5%) patients underwent THV explant due to IE and 188 (50.5%) patients due to BVD. At the index transcatheter aortic valve replacement, patients undergoing THV explant for IE were older (74.3 ± 8.6 vs. 71 ± 10.6 years) and had a lower Society of Thoracic Surgeons risk score [2.6% (1.8-5.0) vs. 3.3% (2.1-5.6), P = .029] compared to patients with BVD. Compared to BVD, IE patients had longer intensive care unit and hospital stays (P < .05) and higher stroke rates at 30 days (8.6% vs. 2.9%, P = .032) and 1 year (16.2% vs. 5.2%, P = .010). Adjusted in-hospital, 30-day, and 1-year mortality was 12.1%, 16.1%, and 33.8%, respectively, for the entire cohort, with no significant differences between groups. Although mortality was numerically higher in IE patients 3 years postsurgery (29.6% for BVD vs. 43.9% for IE), Kaplan-Meier analysis showed no significant differences between groups (P = .16).
CONCLUSIONS
In the EXPLANT-TAVR registry, patients undergoing THV explant for IE had higher 30-day and 1-year stroke rates and longer intensive care unit and hospital stays. Moreover, patients undergoing THV explant for IE had a higher 3-year mortality rate, which did not reach statistical significance given the relatively small sample size of this unique cohort and the reduced number of events.
背景与目的
经导管心脏瓣膜（THV）的外科取出正在迅速增加，但关于与 THV 相关的心内膜炎（IE）患者的数据有限。本研究旨在评估因 IE 而行 THV 取出的患者的结局。
方法
从 EXPLANT-TAVR 登记处的 44 个地点中确定了 2011 年至 2022 年期间所有因 THV 取出的患者。将因 IE 而行 THV 取出的患者与因其他生物瓣功能障碍（BVD）机制而行 THV 取出的患者进行比较。
结果
EXPLANT-TAVR 登记处共纳入 372 例患者。其中，184 例（49.5%）患者因 IE 而行 THV 取出，188 例（50.5%）患者因 BVD 而行 THV 取出。在首次经导管主动脉瓣置换术时，因 IE 而行 THV 取出的患者年龄较大（74.3 ± 8.6 岁 vs. 71 ± 10.6 岁），且胸外科医生协会风险评分较低[2.6%（1.8-5.0）vs. 3.3%（2.1-5.6），P =.029]。与 BVD 相比，IE 患者的 ICU 和住院时间更长（P <.05），30 天和 1 年的卒中发生率更高（8.6% vs. 2.9%，P =.032；16.2% vs. 5.2%，P =.010）。整个队列的院内、30 天和 1 年死亡率分别为 12.1%、16.1%和 33.8%，两组之间无显著差异。尽管术后 3 年 IE 患者的死亡率数值更高（BVD 为 29.6%，IE 为 43.9%），但 Kaplan-Meier 分析显示两组之间无显著差异（P =.16）。
结论
在 EXPLANT-TAVR 登记处，因 IE 而行 THV 取出的患者 30 天和 1 年的卒中发生率更高，且 ICU 和住院时间更长。此外，因 IE 而行 THV 取出的患者 3 年死亡率更高，但由于这一独特队列的样本量相对较小，且事件数量较少，因此未达到统计学意义。
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