Mangner Norman, Schrader Manuela, Haussig Stephan, Kiefer Philipp, Leontyev Sergey, Kappert Utz, Alexiou Konstantin, Crusius Lisa, Erbs Sandra, Gasior Tomasz, Steul Jean-Honoré, Goto Keita, Trausch Anne, Hommel Jennifer, Abdel-Wahab Mohamed, Borger Michael A, Holzhey David, Linke Axel, Woitek Felix J
Herzzentrum Dresden, Department of Internal Medicine and Cardiology, Technische Universität Dresden, Fetscherstr. 76, 01307 Dresden, Germany.
Department of Internal Medicine/Cardiology, Heart Center Leipzig, University of Leipzig, 04289 Leipzig, Germany.
J Clin Med. 2024 Dec 29;14(1):135. doi: 10.3390/jcm14010135.
Patients with end-stage kidney disease (ESRD) represent a high-risk population in terms of both development of and death by cardiovascular diseases. Outcome data of ESRD patients with severe aortic valve stenosis (AS) treated by transcatheter aortic valve implantation (AVI) are scarce. We aim to compare the outcome of ESRD patients undergoing transfemoral (TF) or transapical (TA) AVI. From June 2006 to December 2019, 176 consecutive patients with ESRD receiving chronic hemodialysis underwent TF- or TA-AVI at two German heart centers. The primary outcome measure was 1-year all-cause mortality. Other outcomes included VARC-3 defined device success and early safety. The cohort comprised 61 (34.7%) patients receiving TA-AVI and 115 (65.3%) patients receiving TF-AVI. Perioperative risk, assessed using the EuroScore II, was not different between groups. VARC-3 defined device success (52.5% vs. 80.0%, < 0.001) and early safety (27.9% vs. 45.2%, = 0.025) were lower in TA-AVI patients compared to the TF-AVI group. The 30-day mortality was 4.7-fold higher in TA- compared TF-AVI patients (24.6% vs. 5.2%, < 0.001). The 1-year mortality was higher in TA- compared with TF-AVI patients (57.3% vs. 27.8%, < 0.001). By applying a Cox regression analysis, it was found that TA-AVI was the only independent factor associated with 1-year all-cause mortality (HR 2.65 (95%-CI 1.63-4.30), < 0.001). In ESRD patients, TA-AVI was associated with worse early outcomes and increased mortality up to 1 year compared to the TF-AVI. Transfemoral access is recommended, when feasible, in ESRD patients undergoing TAVI.
终末期肾病（ESRD）患者在心血管疾病的发生和死亡方面均属于高危人群。关于经导管主动脉瓣植入术（AVI）治疗严重主动脉瓣狭窄（AS）的ESRD患者的结局数据较为匮乏。我们旨在比较接受经股动脉（TF）或经心尖（TA）AVI的ESRD患者的结局。2006年6月至2019年12月，176例接受慢性血液透析的连续性ESRD患者在两个德国心脏中心接受了TF-或TA-AVI。主要结局指标为1年全因死亡率。其他结局包括VARC-3定义的手术成功和早期安全性。该队列包括61例（34.7%）接受TA-AVI的患者和115例（65.3%）接受TF-AVI的患者。使用欧洲心脏手术风险评估系统（EuroScore II）评估的围手术期风险在两组之间无差异。与TF-AVI组相比，TA-AVI患者的VARC-3定义的手术成功（52.5%对80.0%，<0.001）和早期安全性（27.9%对45.2%，=0.025）较低。与TF-AVI患者相比，TA-AVI患者的30天死亡率高4.7倍（24.6%对5.2%，<0.001）。与TF-AVI患者相比，TA-AVI患者的1年死亡率更高（57.3%对27.8%，<0.001）。通过应用Cox回归分析，发现TA-AVI是与1年全因死亡率相关的唯一独立因素（风险比2.65（95%置信区间1.63 - 4.30），<0.001）。在ESRD患者中，与TF-AVI相比，TA-AVI与更差的早期结局和长达1年的死亡率增加相关。对于接受经导管主动脉瓣置换术（TAVI）的ESRD患者，若可行，建议采用经股动脉入路。
