Adrichem Rik, Mattace-Raso A Maarten, Hokken Thijmen W, van den Dorpel Mark M P, de Ronde Marjo J A G, Lenzen Mattie J, Cummins Paul A, Kardys Isabella, Nuis Rutger-Jan, Daemen Joost, Bekkers Jos A, Van Mieghem Nicolas M
Department of Cardiology, Erasmus University Medical Centre, Rotterdam, The Netherlands.
Department of Cardiothoracic Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands.
Neth Heart J. 2024 Oct;32(10):348-355. doi: 10.1007/s12471-024-01888-2. Epub 2024 Aug 20.
Transcatheter aortic valve implantation (TAVI) is considered a safe and effective alternative to surgical aortic valve replacement (SAVR) for elderly patients across the operative risk spectrum. In the Netherlands, TAVI is reimbursed only for patients with a high operative risk. Despite this, one fifth of TAVI patients are < 75 years of age. We aim to compare patient characteristics and outcomes of TAVI and SAVR patients < 75 years.
This study included all patients < 75 years without active endocarditis undergoing TAVI or SAVR for severe aortic stenosis, mixed aortic valve disease or degenerated aortic bioprosthesis between 2015 and 2020 at the Erasmus University Medical Centre. Dutch authority guidelines were used to classify operative risk.
TAVI was performed in 292 patients, SAVR in 386 patients. Based on the Dutch risk algorithm, 59.6% of TAVI patients and 19.4% of SAVR patients were at high operative risk. There was no difference in 30-day all-cause mortality between TAVI and SAVR (2.4% vs 0.8%, p = 0.083). One-year and 5‑year mortality was higher after TAVI than after SAVR (1-year: 12.5% vs 4.3%, p < 0.001; 5‑year: 36.8% vs 12.0%, p < 0.001). Within risk categories we found no difference between treatment strategies. Independent predictors of mortality were cardiovascular comorbidities (left ventricular ejection fraction < 30%, atrial fibrillation, pulmonary hypertension) and the presence of malignancies, liver cirrhosis or immunomodulatory drug use.
At the Erasmus University Medical Centre, in patients < 75 years, TAVI is selected for higher-risk phenotypes and overall has higher long-term mortality than SAVR. We found no evidence for worse outcome within risk categories.
经导管主动脉瓣植入术（TAVI）被认为是手术主动脉瓣置换术（SAVR）的一种安全有效的替代方案，适用于手术风险范围各异的老年患者。在荷兰，TAVI仅对手术风险高的患者进行报销。尽管如此，五分之一的TAVI患者年龄小于75岁。我们旨在比较年龄小于75岁的TAVI和SAVR患者的特征及结局。
本研究纳入了2015年至2020年期间在伊拉斯姆斯大学医学中心接受TAVI或SAVR治疗的所有年龄小于75岁、无活动性心内膜炎且患有严重主动脉瓣狭窄、混合性主动脉瓣疾病或退化性主动脉生物瓣膜的患者。采用荷兰权威指南对手术风险进行分类。
292例患者接受了TAVI，386例患者接受了SAVR。根据荷兰风险算法，59.6%的TAVI患者和19.4%的SAVR患者手术风险高。TAVI和SAVR患者的30天全因死亡率无差异（2.4%对0.8%，p = 0.083）。TAVI后的1年和5年死亡率高于SAVR（1年：12.5%对4.3%，p < 0.001；5年：36.8%对12.0%，p < 0.001）。在风险类别中，我们发现治疗策略之间没有差异。死亡率的独立预测因素是心血管合并症（左心室射血分数<30%、心房颤动、肺动脉高压）以及是否存在恶性肿瘤、肝硬化或使用免疫调节药物。
在伊拉斯姆斯大学医学中心，对于年龄小于75岁的患者，TAVI适用于风险较高的表型，总体长期死亡率高于SAVR。我们没有发现风险类别内结局更差的证据。
