Hohri Yu, Faridmoayer Erfan, Zhao Yanling, Kurlansky Paul, Patel Krushang, Moroi Morgan, Yang Christine, Ferrari Giovanni, George Isaac, Takayama Hiroo, Takeda Koji
Division of Cardiothoracic and Vascular Surgery, Department of Surgery, New York Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY.
Center for Innovation and Outcomes Research, New York Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY.
JTCVS Open. 2024 Dec 24;24:217-226. doi: 10.1016/j.xjon.2024.12.010. eCollection 2025 Apr.
Although surgery remains the gold standard treatment for acute valvular dysfunction complicated by cardiogenic shock, transcatheter management has emerged as an alternative. We examined our contemporary experience with patients requiring surgical or transcatheter interventions in conjunction with mechanical circulatory support for acute valvular dysfunction complicated by cardiogenic shock.
We retrospectively reviewed patients admitted with cardiogenic shock due to acute valvular dysfunction who underwent valve interventions at our center between 2016 and 2022. The primary end point was in-hospital mortality. Secondary end points included midterm mortality and major adverse cardiac events, including cardiac death, stroke, cardiac-related events, readmission for heart failure, and reintervention.
Among 67 patients (median 75 years, interquartile range, 65-84), common valve pathologies included aortic stenosis (30 patients), mitral regurgitation (24 patients), and tricuspid regurgitation (17 patients). Preoperative mechanical circulatory support was required in 38 patients. Nineteen patients underwent open surgery, and 48 patients received transcatheter interventions, including transcatheter aortic valve replacement and edge-to-edge mitral repair. Mechanical circulatory support was required in 34 patients postoperatively. Overall in-hospital mortality was 26.9% (surgery 26.3% vs transcatheter 27.1%, = 1.000). Median follow-up was 25.1 months (interquartile range, 20.6-33.9 months). The 2-year survival was 54.0% (95% CI, 42.2-69.0), and the cumulative incidence of major adverse cardiac events was 51.5% (95% CI, 33.8-64.4). Residual moderate or severe tricuspid regurgitation (hazard ratio, 2.266, 95% CI, 1.052-4.940, = .037) and postoperative mechanical circulatory support (hazard ratio, 2.611, 95% CI, 1.194-5.965, = .016) were associated with 2-year mortality.
Early and midterm mortality and morbidity rates remained high despite contemporary multimodal treatment approaches for acute valvular dysfunction with cardiogenic shock.
尽管手术仍然是治疗并发心源性休克的急性瓣膜功能障碍的金标准，但经导管治疗已成为一种替代方法。我们研究了我们在当代对于需要手术或经导管干预并联合机械循环支持来治疗并发心源性休克的急性瓣膜功能障碍患者的经验。
我们回顾性分析了2016年至2022年间在我们中心因急性瓣膜功能障碍并发心源性休克而入院并接受瓣膜干预的患者。主要终点是住院死亡率。次要终点包括中期死亡率和主要不良心脏事件，包括心源性死亡、中风、心脏相关事件、因心力衰竭再次入院以及再次干预。
在67例患者（中位年龄75岁，四分位间距65 - 84岁）中，常见的瓣膜病变包括主动脉瓣狭窄（30例患者）、二尖瓣反流（24例患者）和三尖瓣反流（17例患者）。38例患者术前需要机械循环支持。19例患者接受了开放手术，48例患者接受了经导管干预，包括经导管主动脉瓣置换术和二尖瓣缘对缘修复术。34例患者术后需要机械循环支持。总体住院死亡率为26.9%（手术组26.3% vs 经导管治疗组27.1%，P = 1.000）。中位随访时间为25.1个月（四分位间距20.6 - 33.9个月）。2年生存率为54.0%（95%CI，42.2 - 69.0），主要不良心脏事件的累积发生率为51.5%（95%CI，33.8 - 64.4）。残余中度或重度三尖瓣反流（风险比，2.266，95%CI，1.052 - 4.940，P = 0.037）和术后机械循环支持（风险比，2.611，95%CI，1.194 - 5.965，P = 0.016）与2年死亡率相关。
尽管对于并发心源性休克的急性瓣膜功能障碍采用了当代多模式治疗方法，但早期和中期的死亡率和发病率仍然很高。
