The role of the heart team in complicated transcatheter aortic valve implantation: a 7-year single-centre experience
The role of the heart team in complicated transcatheter aortic valve implantation: a 7-year single-centre experience
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DOI：
10.1093/ejcts/ezu379
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发表时间：
2015-06-01
影响因子：
3.4
通讯作者：
Holzhey, David Michael
中科院分区：
文献类型：
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作者：
Kiefer, Philipp;Seeburger, Joerg;Holzhey, David Michael
欧洲指南推荐在多学科心脏团队中进行经导管主动脉瓣植入（TAVI）。然而，尽管有现有的指导方针，在专业中心之外进行TAVI还是有很强的动力。本研究的目的是通过对TAVI期间/之后需要手术治疗的并发症提供清晰的见解，阐明现场心脏手术的必要性。自2006年2月以来，共有2287例患者（1523例经股动脉，752例经根尖，12例经主动脉）接受了TAVI，平均年龄为84.5±5.3岁，平均log EuroSCORE为21.7±16.3，其中205例为女性（84%）。所有需要手术干预的手术相关并发症，无论是立即的还是延迟的，但在最初的住院期间，都被记录和回顾性分析。在该队列中，245例（10.7%）患者因主要并发症需要手术治疗。共有42例（1.8%）患者转换为全胸骨切开术，27例（1.2%）患者依赖于短期使用心肺机。85例（3.7%）患者出现手术干预后的血管并发症，54例（2.4%）患者在初次住院期间必须进行开胸手术，15例（0.7%）患者需要再次进行心脏手术。TAVI期间只能通过手术解决的严重并发症将继续发生。因此，每次TAVI手术都应由心脏外科医生和专业中心内经验丰富的团队进行或陪同。
European guidelines recommend to perform transcatheter aortic valve implantation (TAVI) within a multidisciplinary heart team. However, there is a strong drive-despite existing guidelines-to perform TAVI outside of specialized centres. The aim of this study was to clarify the necessity of on-site cardiac surgery by providing a clear insight into the complications during/after TAVI that needed surgical management.A total of 2287 (1523 transfemoral, 752 transapical and 12 transaortic) patients, with a mean age of 84.5 +/- 5.3 years, and a mean log EuroSCORE of 21.7 +/- 16.3, of which 205 were female (84%), underwent TAVI since February 2006 at our institution. All procedure-related complications that required surgical interventions, whether immediate or delayed but within the initial hospital stay, were recorded and retrospectively analysed.Out of this cohort, 245 (10.7%) patients required surgical treatment due to major complications. A total of 42 patients (1.8%) underwent conversion to full sternotomy and 27 (1.2%) were dependent on the short-term use of the heart-lung machine. Vascular complications with surgical intervention were seen in 85 patients (3.7%), 54 patients (2.4%) had to have a rethoracotomy within their initial stay and 15 (0.7%) required a cardiac reoperation.Severe complications during TAVI that can only be resolved surgically will continue to occur. Therefore, each TAVI procedure should be conducted or accompanied by a cardiac surgeon and an experienced team within a specialized centre.