经心尖与经腋动脉入路在经导管主动脉瓣植入术中的应用：使用治疗权重反概率分析的比较死亡率和长期结局
Transapical vs. Transaxillary Access in Transcatheter Aortic Valve Implantation: Comparative Mortality and Long-Term Outcomes Using Inverse Probability of Treatment Weighting Analysis.
作者信息
Schrader Helene, Wiedenhofer Julia M, Berlinghof Sophie, Ducaruge Juliane, Brand Anna, Spethmann Sebastian, Landmesser Ulf, Blaschke Florian, Grubitzsch Herko, Falk Volkmar, Klein Christoph, Unbehaun Axel, Sherif Mohammad, Dreger Henryk, Trippel Tobias D, Primessnig Uwe, Sündermann Simon H
机构信息
Deutsches Herzzentrum der Charité, Department of Cardiology, Angiology and Intensive Care Medicine, Campus Virchow Klinikum-Augustenburger Platz 1, 13353 Berlin, Germany.
Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany.
出版信息
J Clin Med. 2025 Mar 25;14(7):2235. doi: 10.3390/jcm14072235.
Transcatheter aortic valve implantation (TAVI) is the treatment of choice for symptomatic aortic stenosis in patients with moderate to high surgical risk. When transfemoral access is unsuitable, alternative routes such as transapical (TAP) or transaxillary (TAX) routes must be considered. This study compares the in-hospital mortality and clinical outcomes of TAP vs. TAX TAVI. We conducted a retrospective analysis of 76 patients who underwent TAP or TAX TAVI between 2018 and 2021 at our department. Inverse probability of treatment weighting (IPTW) was used to account for baseline differences. Among 1901 TAVI procedures, a total of 76 was selected of which TAP was performed in 34.2% ( = 26), and TAX in 65.8% ( = 50) of cases. Self-expanding CoreValve Evolut R valve prostheses were used in 96% of TAX cases, while balloon-expandable Edwards SAPIEN 3 valve prostheses were exclusively implanted in TAP cases. After IPTW adjustment, baseline characteristics, including EuroSCORE II, LVEF, and NYHA class, were comparable. TAX was associated with a higher pacemaker implantation rate (22.6% vs. 0%; = 0.032), while TAP had a higher incidence of late bacteremia (13.4% vs. 1.6%; = 0.027) and longer hospitalization (19 [13, 28] vs. 10 [8, 21] days; = 0.016). In-hospital (0% vs. 2.1%; = 0.388), 30-day (3.4% vs. 3.5%; = 0.957), and 3-year mortality (6.7% vs. 4.8%; = 0.709) were similar. Device implantation success was 100% in both groups. Major bleeding and vascular complications were rare. Balloon predilatation was more frequent in TAX (57.6% vs. 13.3%; = 0.002). Rates of mild and moderate aortic regurgitation did not differ. In patients unsuitable for transfemoral TAVI, TAP was associated with lower pacemaker rates but longer hospitalization and increased late bacteremia compared to TAX. Both approaches showed comparable safety and efficacy, emphasizing the need for individualized access selection.
经导管主动脉瓣植入术（TAVI）是手术风险中到高的有症状主动脉瓣狭窄患者的首选治疗方法。当经股动脉入路不合适时，必须考虑其他入路，如经心尖（TAP）或经腋动脉（TAX）入路。本研究比较了经心尖与经腋动脉TAVI的住院死亡率和临床结局。我们对2018年至2021年在我科接受经心尖或经腋动脉TAVI的76例患者进行了回顾性分析。采用治疗权重逆概率（IPTW）来解释基线差异。在1901例TAVI手术中，共选取76例，其中34.2%（=26例）采用经心尖入路，65.8%（=50例）采用经腋动脉入路。96%的经腋动脉入路病例使用了自膨胀CoreValve Evolut R瓣膜假体，而经心尖入路病例仅植入了球囊扩张式Edwards SAPIEN 3瓣膜假体。经过IPTW调整后，包括欧洲心脏手术风险评估系统II（EuroSCORE II）、左心室射血分数（LVEF）和纽约心脏协会（NYHA）分级在内的基线特征具有可比性。经腋动脉入路与更高的起搏器植入率相关（22.6%对0%；P=0.032），而经心尖入路的晚期菌血症发生率更高（13.4%对1.6%；P=0.027）且住院时间更长（19[13，28]天对10[8，21]天；P=0.016）。住院死亡率（0%对2.1%；P=0.388）、30天死亡率（3.4%对3.5%；P=0.957）和3年死亡率（6.7%对4.8%；P=0.709）相似。两组的器械植入成功率均为100%。严重出血和血管并发症很少见。经腋动脉入路的球囊预扩张更频繁（57.6%对13.3%；P=0.002）。轻度和中度主动脉瓣反流的发生率没有差异。在不适合经股动脉TAVI的患者中，与经腋动脉入路相比，经心尖入路的起搏器植入率较低，但住院时间更长且晚期菌血症增加。两种方法显示出相当的安全性和有效性，强调了个体化入路选择的必要性。
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