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[经皮主动脉瓣人工瓣膜感染性心内膜炎:与外科生物瓣膜的比较]

[[Infectious endocarditis on percutaneous aortic valve prosthesis: comparison with surgical bioprostheses]].

作者信息

Barreiro Lucas, Roldán Álvaro, Aguayo Nerea, Urbano Cristina, Crespín Manuel, López José, González Rafael, Castillo Juan Carlos, Mesa Dolores, Ruiz Martín, Perea Jorge, Gallo Ignacio, de Lezo Javier Suárez, Ojeda Soledad, Pan Manuel, Anguita Manuel

机构信息

Servicio de Cardiología, Hospital Universitario Reina Sofía, Córdoba, España Servicio de Cardiología Hospital Universitario Reina Sofía Córdoba España.

Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, España Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC) Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC) Córdoba España.

出版信息

REC Interv Cardiol. 2025 Jan 2;7(2):75-81. doi: 10.24875/RECIC.M24000492. eCollection 2025 Apr-Jun.

Abstract

INTRODUCTION AND OBJECTIVES

Infective endocarditis (IE) is a rare but serious complication in patients with aortic valve stenosis undergoing transcatheter aortic valve implantation (TAVI). The spread of this technique to lower risk patients means that this complication may increase. The objective of this study was to analyze the incidence and mortality of IE in TAVI patients vs patients undergoing surgical aortic valve replacement (SAVR).

METHODS

We conducted an observational, single-center, retrospective cohort study that included all cases of IE diagnosed consecutively in a Spanish reference center from 2008 through 2022 in patients with TAVI vs SAVR.

RESULTS

The study included a total of 10 cases of IE in 778 patients treated with TAVI, with an incidence rate of 0.09/100 patients/year vs an incidence rate of 0.12/100 patients/year in surgical bioprostheses with 24 cases in 1457 patients ( = .64) (median follow-up of 49 months (p25-p75: 29-108). Clinical features were very similar, with 50% of TAVI patients having cardiac complications vs 33% of SAVR patients ( = .33). Although 40% of the patients from the TAVI group had a surgical indication for IE and 50% for SAVR, = .49), only half of them underwent surgery in both groups (20% TAVI vs 25% SAVR; = .93). No differences were reported in the 1-year mortality rate (30% TAVI vs 29% SAVR; = .56).

CONCLUSIONS

The incidence rate of IE in this long series of TAVI patients was low and despite the worse clinical profile of TAVI patients, no significant mortality differences were found compared with the group of patients with surgical bioprosthesis.

摘要

引言与目的

感染性心内膜炎(IE)是经导管主动脉瓣植入术(TAVI)治疗的主动脉瓣狭窄患者中一种罕见但严重的并发症。该技术应用于风险较低的患者意味着这种并发症可能会增加。本研究的目的是分析TAVI患者与接受外科主动脉瓣置换术(SAVR)患者中IE的发生率和死亡率。

方法

我们进行了一项观察性、单中心、回顾性队列研究,纳入了2008年至2022年在西班牙一家参考中心连续诊断为IE的所有TAVI患者与SAVR患者。

结果

该研究共纳入778例接受TAVI治疗的患者中的10例IE病例,发病率为0.09/100患者/年,而1457例接受外科生物瓣膜置换术的患者中有24例IE病例,发病率为0.12/100患者/年(P = 0.64)(中位随访49个月(第25百分位数-第75百分位数:29-108))。临床特征非常相似,50%的TAVI患者有心脏并发症,而SAVR患者为33%(P = 0.33)。尽管TAVI组40%的患者有IE的手术指征,SAVR组为50%(P = 0.49),但两组中只有一半患者接受了手术(TAVI组为20%,SAVR组为25%;P = 0.93)。1年死亡率无差异(TAVI组为30%,SAVR组为29%;P = 0.56)。

结论

在这一长系列TAVI患者中,IE的发病率较低,尽管TAVI患者的临床情况较差,但与接受外科生物瓣膜置换术的患者组相比,未发现显著的死亡率差异。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/519f/12118561/339d900d530a/2604-7306-recic-7-2-75-en-gf1.jpg

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