Lauten Philipp, Kreutz Julian, Costello-Boerrigter Lisa C, Schreiber Mathias, Boerrigter Guido, Albert Christian, El Garhy Mohammad, Göbel Björn, Schieffer Bernhard, Lapp Harald, Owais Tamer, Kuntze Thomas, Markus Birgit
Heart Center/Structural Heart, Zentralklinik Bad Berka, Bad Berka, Germany
Philipps University of Marburg, Marburg, Germany.
Open Heart. 2025 Jan 30;12(1):e003069. doi: 10.1136/openhrt-2024-003069.
Current guidelines recommend transcatheter aortic valve implantation (TAVI) for patients with aortic stenosis and porcelain aorta (PA). Neurological outcomes of patients with PA undergoing TAVI with modern valves require clarification as most trials examined balloon-expandable valves (BEV) and self-expandable valves in intermediate or high-risk patients, but not specifically in patients with PA. Our aim was to compare outcomes, including stroke and mortality, in well-matched patients with and without PA who received BEV during transfemoral TAVI procedures.
Consecutive patients undergoing TAVI were entered into a registry. For this single-centre (Zentralklinik Bad Berka, Germany), retrospective analysis, we only selected patients who received BEV. PA diagnosis was made when non-contrast axial CT images fulfilled Valve Academic Research Consortium-2 criteria for PA. There was 2:1 nearest neighbour matching of patients without and with PA. The primary outcome measure was 30-day mortality or stroke within 72 hours. Secondary outcome measures were 30-day mortality, stroke within 72 hours, technical success and 30-day device success.
After matching patients with (n=141) and without PA (n=282), the primary outcome of mortality at <30 days or stroke within 72 hours was higher in PA versus non-PA (7.8% vs 2.5%; OR 3.32 (95% CI 1.25 to 8.85); p=0.019). With regard to secondary outcomes, PA was not associated with mortality at 30 days (4.3% vs 2.1%; OR 2.04 (95% CI 0.65 to 6.48); p=0.23); however, stroke within 72 hours was significantly higher in PA versus non-PA (3.5% vs 0.4%; OR 10.33 (95% CI 1.17 to 91.12); p=0.017). Technical and device success were uninfluenced by PA.
Transfemoral TAVI with BEV in patients with PA was associated with a higher risk of the primary combined endpoint of mortality at 30 days or stroke within 72 hours, which was primarily driven by stroke within 72 hours. These findings might influence cerebral embolic protection device use in patients with PA.
当前指南推荐对患有主动脉狭窄和瓷化主动脉（PA）的患者进行经导管主动脉瓣植入术（TAVI）。对于接受现代瓣膜TAVI治疗的PA患者的神经学转归需要进一步明确，因为大多数试验研究的是球囊扩张瓣膜（BEV）以及中高危患者使用的自膨胀瓣膜，而非专门针对PA患者。我们的目的是比较在经股动脉TAVI手术中接受BEV治疗的、匹配良好的有PA和无PA患者的转归，包括卒中及死亡率。
连续接受TAVI治疗的患者被纳入一项登记研究。对于这项单中心（德国巴特贝卡中央诊所）回顾性分析，我们仅选择接受BEV治疗的患者。当非增强轴向CT图像符合瓣膜学术研究联盟-2关于PA的标准时，即诊断为PA。对无PA和有PA的患者进行2:1最近邻匹配。主要结局指标为30天内死亡率或72小时内卒中。次要结局指标为30天死亡率、72小时内卒中、技术成功率和30天器械成功率。
在对有PA（n = 141）和无PA（n = 282）的患者进行匹配后，PA患者30天内死亡率或72小时内卒中这一主要结局高于无PA患者（7.8% 对2.5%；OR 3.32（95% CI 1.25至8.85）；p = 0.******）。关于次要结局，PA与30天死亡率无关（4.3% 对2.1%；OR 2.04（95% CI 0.65至6.48）；p = 0.23）；然而，PA患者72小时内卒中显著高于无PA患者（3.5% 对0.4%；OR 10.33（95% CI 1.17至91.12）；p = 0.017）。技术成功率和器械成功率不受PA影响。
PA患者经股动脉使用BEV进行TAVI与30天内死亡率或72小时内卒中这一主要联合终点的较高风险相关，这主要由72小时内卒中所驱动。这些发现可能会影响PA患者脑栓塞保护装置的使用。
