低危主动脉瓣狭窄患者单纯外科手术与经导管主动脉瓣置换术的中期临床转归。
Midterm Clinical Outcomes after Isolated Surgical and Transcatheter Aortic Valve Replacement in Low-Risk Patients with Aortic Stenosis.
机构信息
Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.
Division of Biostatistics, Center for Clinical Research, National Center for Child Health and Development, Tokyo, Japan.
出版信息
Ann Thorac Cardiovasc Surg. 2024;30(1). doi: 10.5761/atcs.oa.24-00123.
PURPOSE
This study aimed to compare the clinical outcomes of isolated surgical aortic valve replacement (SAVR) and transfemoral (TF)-transcatheter aortic valve replacement (TAVR) in low-risk aortic stenosis (AS) patients.
METHODS
A total of 696 low-risk (Society of Thoracic Surgeons score <4%) AS patients underwent isolated SAVR or TF-TAVR at five centers. After 1:1 propensity score matching, 159 pairs were identified. Early and follow-up events, including cardiac mortality and major adverse cardiac and cerebrovascular events (MACCE: all-cause mortality, heart failure admission, reoperation, prosthetic valve endocarditis, and stroke), were compared.
RESULTS
Baseline characteristics are similar between the matched groups. There were no 30-day cardiac mortalities in either group. All-cause mortality and MACCE at 30 days did not differ. During 5-year follow-up (median 3.1 [range 0-7.2] years), the incidence of cardiac mortality (1.3% vs. 18.9%; adjusted hazard ratio [aHR], 8.89; 95% confidence interval [CI], 2.68-29.53; P <0.001), all-cause mortality (4.2% vs. 33.9%; aHR, 8.56; 95% CI, 3.41-21.45; P <0.001), and MACCE (25.1% vs. 47.0%; aHR, 2.36; 95% CI, 1.54-3.63; P <0.001) were lower in the SAVR group than in the TAVR group.
CONCLUSIONS
Isolated SAVR demonstrated better outcomes in low-risk AS patients. TAVR in this subset should be chosen carefully.
目的
本研究旨在比较低危主动脉瓣狭窄（AS）患者行单纯外科主动脉瓣置换术（SAVR）与经股（TF）-经导管主动脉瓣置换术（TAVR）的临床结局。
方法
共有 696 例低危（胸外科医师学会评分＜4%）AS 患者在五家中心行单纯 SAVR 或 TF-TAVR。经 1:1 倾向评分匹配后，共匹配了 159 对。比较早期和随访事件，包括心源性死亡和主要心脏和脑血管不良事件（MACCE：全因死亡率、心力衰竭入院、再次手术、人工瓣膜心内膜炎和中风）。
结果
匹配组的基线特征相似。两组均无 30 天心源性死亡。全因死亡率和 30 天 MACCE 无差异。5 年随访期间（中位数 3.1[范围 0-7.2]年），SAVR 组的心脏死亡率（1.3% vs. 18.9%；调整后的风险比[aHR]，8.89；95%置信区间[CI]，2.68-29.53；P<0.001）、全因死亡率（4.2% vs. 33.9%；aHR，8.56；95%CI，3.41-21.45；P<0.001）和 MACCE（25.1% vs. 47.0%；aHR，2.36；95%CI，1.54-3.63；P<0.001）均低于 TAVR 组。
结论
单纯 SAVR 为低危 AS 患者带来更好的结局。在这部分患者中，TAVR 应谨慎选择。
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