Vascular Surgery, University of Bologna-DIMEC, Bologna, Italy.
Vascular Surgery unit, IRCCS Azienda Ospedaliero-universitaria di Bologna.
Eur J Cardiothorac Surg. 2024 Nov 4;66(5). doi: 10.1093/ejcts/ezae379.
Thoracic/abdominal aortic aneurysms and aortic stenosis may be concomitant diseases requiring both transcatheter aortic valve implantation (TAVI) and endovascular aneurysm repair (T/EVAR) in high-risk patients for surgical approaches, but temporal management is not clearly defined yet. The aim of the study was to analyse outcomes of simultaneous versus staged TAVI and T/EVAR.
Retrospective observational multicentre study was performed on patients requiring TAVI and T/EVAR from 2016 to 2022. Patients were divided into 2 groups: 'Simultaneous group' if T/EVAR + TAVI were performed in the same procedure and 'Staged group' if T/EVAR and TAVI were performed in 2 steps, but within 3 months. Primary outcomes were technical success, 30-day mortality/major adverse events and follow-up survival. Secondary outcomes were procedural metrics and length of stay.
Forty-four cases were collected; 8 (18%) had T/EVAR and 36 (82%) had EVAR, respectively. Upon temporal determination, 25 (57%) and 19 (43%) were clustered in Simultaneous and Staged groups, respectively. In Staged group, median time between procedures was 72 (interquartile range-IQR: 57-87) days. Preoperative and intraoperative figures were similar. There was no difference in 30-day mortality (Simultaneous: 0/25 versus Staged: 1/19; P = 0.43). Pulmonary events (Simultaneous: 0/25 versus Staged: 5/19; P = 0.01) and need of postoperative cardiac pacemaker (Simultaneous: 2/25 versus Staged: 7/19; P = 0.02) were more frequent in Staged patients. The overall length of stay was lower in the Simultaneous group [Simultaneous: 7 (IQR: 6-8) versus Staged: 19 (IQR: 15-23) days; P = 0.001]. The median follow-up was 25 (IQR: 8-42) months and estimated 3-year survival was 73% with no difference between groups (Simultaneous: 82% versus Staged: 74%; P = 0.90).
Both Simultaneous or Staged T/EVAR and TAVI procedures are effective with satisfactory outcomes. Despite the small numbers, simultaneous repair seems to reduce length of stay and pulmonary complications, maintaining similar follow-up survival.
胸/腹主动脉瘤和主动脉瓣狭窄可能是需要同时进行经导管主动脉瓣植入术（TAVI）和血管内动脉瘤修复术（T/EVAR）的并存疾病，对于手术方法而言，高危患者需要同时进行这两种手术，但目前尚不清楚其时间管理策略。本研究旨在分析同期与分期 TAVI 和 T/EVAR 的治疗效果。
本研究为回顾性观察性多中心研究，纳入了 2016 年至 2022 年期间需要 TAVI 和 T/EVAR 的患者。患者分为两组：“同期组”如果 T/EVAR + TAVI 在同一手术中进行，“分期组”如果 T/EVAR 和 TAVI 在两步进行，但在 3 个月内完成。主要结局为技术成功率、30 天死亡率/主要不良事件和随访生存率。次要结局为手术指标和住院时间。
共收集了 44 例患者；8 例（18%）接受了 T/EVAR，36 例（82%）接受了 EVAR。根据时间确定，25 例（57%）和 19 例（43%）分别被分为同期组和分期组。分期组中，两次手术之间的中位时间为 72 天（四分位距-IQR：57-87 天）。术前和术中数据相似。30 天死亡率无差异（同期组：0/25 例与分期组：1/19 例；P=0.43）。同期组肺部事件（0/25 例与分期组：5/19 例；P=0.01）和术后需要心脏起搏器（0/25 例与分期组：7/19 例；P=0.02）更为常见。同期组的总住院时间更短[同期组：7（IQR：6-8）天与分期组：19（IQR：15-23）天；P=0.001]。中位随访时间为 25 个月（IQR：8-42 个月），两组 3 年生存率估计为 73%，无差异（同期组：82%与分期组：74%；P=0.90）。
同期或分期 T/EVAR 和 TAVI 手术均有效，且预后良好。尽管样本量较小，但同期修复似乎可以减少住院时间和肺部并发症，同时保持相似的随访生存率。
