Poinsignon Hugo, Godin Matthieu, Landolff Quentin, Heroguelle Virginie, Villecourt Aurélien, Tassan-Mangina Sophie, Metz Damien, Koning René, Devaux Bruno, Canville Alexandre, Faroux Laurent
Reims University Hospital, 51100 Reims, France.
Clinique Saint-Hilaire, 76000 Rouen, France.
Arch Cardiovasc Dis. 2025 Jun-Jul;118(6-7):374-381. doi: 10.1016/j.acvd.2025.02.003. Epub 2025 Mar 17.
The rapid and exponential growth in demand for transcatheter aortic valve implantation (TAVI) tends to overwhelm current capacity, leading to prolonged waiting times for TAVI.
To investigate current waiting times for TAVI, the incidence of death on waiting list for TAVI, clinical characteristics and factors predictive of death before TAVI.
A total of 1495 patients referred for TAVI in two French centres (TAVI centre, n=790; and non-TAVI centre, n=705) were included for analysis.
The mean age of the population was 82years. The median waiting time was 79 (interquartile range: 49-119) days, and was longer in the non-TAVI centre than in the TAVI centre (105 vs. 64days; P<0.001). The overall rate of death on waiting list was 5.8% (n=86), with the majority of deaths related to cardiovascular causes. Most patients (63%) died within the first 2months on the waiting list, with a linear occurrence of death without clear threshold. Impaired renal function (odds ratio: 2.12, 95% confidence interval: 1.30-3.45; P=0.003) and left ventricular ejection fraction<50% (odds ratio: 2.90, 95% confidence interval: 1.83-4.62; P<0.001) were identified as independent predictors of death on waiting list.
The delay between patient referral and TAVI procedure is longer than 2.5months in half of cases, with a steady increase over the years and longer delays in centres without on-site TAVI facilities. One in 20 patients dies while on the waiting list for TAVI, with two thirds of deaths occurring within the first 2months on the waiting list. Impaired renal function and left ventricular ejection fraction<50% determine an increased risk of death.
经导管主动脉瓣植入术（TAVI）需求的快速指数增长往往使当前的能力不堪重负，导致TAVI等待时间延长。
调查TAVI的当前等待时间、TAVI等待名单上的死亡发生率、临床特征以及TAVI前死亡的预测因素。
纳入法国两个中心共1495例接受TAVI评估的患者（TAVI中心790例，非TAVI中心705例）进行分析。
研究人群的平均年龄为82岁。中位等待时间为79天（四分位间距：49 - 119天），非TAVI中心的等待时间长于TAVI中心（105天对64天；P<0.001）。等待名单上的总体死亡率为5.8%（n = 86），大多数死亡与心血管原因有关。大多数患者（63%）在等待名单的前2个月内死亡，死亡呈线性发生，无明确阈值。肾功能受损（比值比：2.12，95%置信区间：1.30 - 3.45；P = 0.003）和左心室射血分数<50%（比值比：2.90，95%置信区间：1.83 - 4.62；P<0.001）被确定为等待名单上死亡的独立预测因素。
在一半的病例中，患者转诊至TAVI手术之间的延迟超过2.5个月，且多年来稳步增加，在没有现场TAVI设施的中心延迟更长。每20例患者中有1例在等待TAVI期间死亡，三分之二的死亡发生在等待名单的前2个月内。肾功能受损和左心室射血分数<50%会增加死亡风险。
