Maeda Koichi, Shimamura Kazuo, Mizote Isamu, Nakamura Daisuke, Yamashita Kizuku, Kawamura Ai, Yoshioka Daisuke, Sakata Yasushi, Miyagawa Shigeru
Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, 565-0871, Osaka, Japan.
Department of Cardiology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, 565-0871, Osaka, Japan.
Gen Thorac Cardiovasc Surg. 2024 Oct 23. doi: 10.1007/s11748-024-02095-x.
Transapical-transcatheter aortic valve replacement is one of the main interventions indicated for patients where access via peripheral vessels is challenging. However, there have been no reports on the long-term outcomes of this intervention. Here, we report the long-term outcomes of this intervention.
Among 178 patients who underwent transapical-transcatheter aortic valve replacement between October 2009 and July 2023, 173 patients who underwent this intervention for native aortic stenosis were included in this study, and early and long-term results were evaluated.
The mean age was 82.4 ± 6.4 years, 52.6% were women, mean body area was 1.46 ± 0.17 m, and the Society of Thoracic Surgeons Predicted Risk of Mortality was 11.2 ± 9.9%. In-hospital mortality was observed in three patients (1.7%). Mean follow-up duration was 4.3 ± 2.8 years, and the survival rates at 1-, 3-, 5-, and 8-years were 84.9%, 67.1%, 47.0%, and 22.1%, respectively. Freedom from cardiovascular mortality at 1, 3, 5, and 8-years was 92.9%, 86.1%, 75.8%, and 53.5%, respectively. The freedom from disabling stroke rates at 1, 3, 5, and 8-years were 95.0%, 92.4%, 92.4%, and 90.8%, respectively. Multivariate analysis revealed that male (Hazard Ratio 1.85, 95%Confidence Interval 1.27-2.70, p = 0.0012) and hemodialysis (Hazard Ratio 1.64, 95%Confidence Interval 1.00-2.67, p = 0.049) were significant poor prognosis factors.
Long-term outcomes of transapical-transcatheter aortic valve replacement were satisfactory. Despite the variety of available approaches, the role of transapical-transcatheter aortic valve replacement, which has low vascular impact, has not been completely lost.
经心尖经导管主动脉瓣置换术是外周血管入路困难患者的主要干预措施之一。然而，关于该干预措施的长期疗效尚无报道。在此，我们报告该干预措施的长期疗效。
在2009年10月至2023年7月期间接受经心尖经导管主动脉瓣置换术的178例患者中，本研究纳入了173例因原发性主动脉瓣狭窄接受该手术的患者，并评估了早期和长期结果。
平均年龄为82.4±6.4岁，女性占52.6%，平均体表面积为1.46±0.17平方米，胸外科医师协会预测死亡率为11.2±9.9%。3例患者（1.7%）发生院内死亡。平均随访时间为4.3±2.8年，1年、3年、5年和8年的生存率分别为84.9%、67.1%、47.0%和22.1%。1年、3年、5年和8年无心血管死亡的发生率分别为92.9%、86.1%、75.8%和53.5%。1年、3年、5年和8年无致残性卒中发生率分别为95.0%、92.4%、92.4%和90.8%。多因素分析显示，男性（风险比1.85，95%置信区间1.27 - 2.70，p = 0.0012）和血液透析（风险比1.64，95%置信区间1.00 - 2.67，p = 0.049）是显著的不良预后因素。
经心尖经导管主动脉瓣置换术的长期疗效令人满意。尽管有多种可用方法，但经心尖经导管主动脉瓣置换术对血管影响较小，其作用尚未完全丧失。
