Yang Chen, Liu Yang, Mao Yu, Shang Xiaoke, Qiao Fan, Liu Jian, Zhou Yenong, Zhai Mengen, Yu Shiqiang, Chen Tao, Yang Jian, Jin Zhenxiao
From the Department of Cardiovascular Surgery, Xijing Hospital, Air Force Medical University, Xi'an, China.
Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
ASAIO J. 2025 Mar 1;71(3):204-212. doi: 10.1097/MAT.0000000000002313. Epub 2024 Sep 24.
A proportion of patients still need mechanical circulatory support (MCS) during the transcatheter aortic valve replacement (TAVR) because of intraoperative hemodynamic instability. However, the outcomes of patients with different MCS type during TAVR are still controversial. A total of 538 patients who underwent TAVR procedure in four centers were included. The time-related outcomes and their predictors of patients who did not have MCS (MCS-, n = 498) were compared with those who underwent emergency MCS (eMCS+, n = 18) and prophylactic MCS (pMCS+, n = 22). We evaluated the association between different MCS groups and all-cause mortality using conditional landmark analysis with Cox regression. There was a significant increase in 30-day mortality in the eMCS+ group ( plog-rank < 0.001) and no significant difference in 31-day to 1-year mortality among the groups ( plog-rank = 0.789). A significant improvement in the left ventricular ejection fraction was observed in the pMCS+ group at 1 year after TAVR. Emergency MCS was independently associated with 30-day mortality, as well as 1-year mortality. Prophylactic MCS showed good clinical outcomes and might be considered for high-risk patients. Further studies are needed to investigate the predictors that lead to MCS usage and long-term mortality in TAVR patients with MCS.
由于术中血流动力学不稳定，一部分患者在经导管主动脉瓣置换术（TAVR）期间仍需要机械循环支持（MCS）。然而，TAVR期间不同MCS类型患者的结局仍存在争议。纳入了在四个中心接受TAVR手术的538例患者。将未使用MCS的患者（MCS-，n = 498）与接受紧急MCS的患者（eMCS+，n = 18）和预防性MCS的患者（pMCS+，n = 22）的时间相关结局及其预测因素进行了比较。我们使用Cox回归的条件性地标分析评估了不同MCS组与全因死亡率之间的关联。eMCS+组30天死亡率显著增加（对数秩检验P<0.001），各组之间31天至1年死亡率无显著差异（对数秩检验P = 0.789）。TAVR术后1年，pMCS+组左心室射血分数有显著改善。紧急MCS与30天死亡率以及1年死亡率独立相关。预防性MCS显示出良好的临床结局，对于高危患者可能会考虑使用。需要进一步研究来调查导致TAVR患者使用MCS和长期死亡率的预测因素。
