Jagadeesan Vikrant, Mehaffey J Hunter, Darehzereshki Ali, Alharbi Anas, Kawsara Mohammad, Daggubati Ramesh, Wei Lawrence, Badhwar Vinay
Department of Cardiology, West Virginia University, Morgantown, West Virginia.
Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, West Virginia.
Ann Thorac Surg. 2025 Jul;120(1):62-70. doi: 10.1016/j.athoracsur.2024.10.013. Epub 2024 Oct 30.
Current evidence supports equipoise between surgical aortic valve replacement (AVR) and transcatheter AVR (TAVR) for the management of symptomatic severe aortic stenosis (AS). The optimal interventional management for lower-risk patients is controversial. Minimally invasive robotic AVR (RAVR) was developed as a potential option.
A total of 605 consecutive patients (2017-2023) managed by the identical structural heart team, 174 RAVR and 431 TAVR, were propensity matched and evaluated for in-hospital and 1-year outcomes.
There were 288 low- to intermediate-risk (The Society of Thoracic Surgeons predicted risk of mortality <8%) patients matched in 2 well-balanced groups (144 RAVR vs 144 TAVR). In-hospital and 30-day mortality were similar. There were 2 conversions to sternotomy in the TAVR group (cardiac arrest and coronary occlusion) and none in the RAVR group. Eight RAVR patients (5.6%) required reoperation for hemothorax evacuation. TAVR was associated with higher new pacemaker (11 vs 3, P = .028) and major vascular complications (13 vs 0, P < .0001), and a higher postprocedural stroke trend (6 vs 1, P = .056). There was no difference in 30-day transfusions, atrial fibrillation, or 1-year mean valve gradients. However, 1-year mortality (12.5% vs 1.4%, P < .0001) and paravalvular leak greater than mild (32.6% vs 2.3%, P < 0.0001) were significantly higher in TAVR.
These data highlight lower pacemaker and vascular complications, as well as less 1-year paravalvular leak and mortality with RAVR compared with TAVR. RAVR may provide a safe and effective minimally invasive alternative to TAVR for low- and intermediate-risk patients presenting with severe symptomatic AS.
目前的证据支持在有症状的严重主动脉瓣狭窄（AS）的治疗中，外科主动脉瓣置换术（AVR）和经导管主动脉瓣置换术（TAVR）之间保持平衡。对于低风险患者的最佳介入治疗存在争议。微创机器人AVR（RAVR）作为一种潜在选择而被开发出来。
由同一结构性心脏病团队管理的总共605例连续患者（2017 - 2023年），174例行RAVR和431例行TAVR，进行倾向匹配并评估其住院期间和1年的结局。
有288例低至中度风险（胸外科医师协会预测的死亡风险<8%）患者匹配入2个平衡良好的组（144例行RAVR vs 144例行TAVR）。住院期间和30天死亡率相似。TAVR组有2例转为胸骨切开术（心脏骤停和冠状动脉闭塞），RAVR组无。8例RAVR患者（5.6%）因胸腔积血清除需要再次手术。TAVR与更高的新起搏器植入率（11例 vs 3例，P = 0.028）和主要血管并发症发生率（13例 vs 0例，P < 0.0001）相关，且术后中风趋势更高（6例 vs 1例，P = 0.056）。30天输血、房颤或1年平均瓣膜梯度方面无差异。然而，TAVR组的1年死亡率（12.5% vs 1.4%，P < 0.0001）和大于轻度的瓣周漏（32.6% vs 2.3%，P < 0.0001）显著更高。
这些数据表明，与TAVR相比，RAVR的起搏器和血管并发症更低，1年瓣周漏和死亡率也更低。对于有严重症状的AS的低至中度风险患者，RAVR可能为TAVR提供一种安全有效的微创替代方案。
