Transcatheter Aortic Valve Implantation in Patients With Very High Risk for Conventional Aortic Valve Replacement
Transcatheter Aortic Valve Implantation in Patients With Very High Risk for Conventional Aortic Valve Replacement
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DOI：
10.1016/j.athoracsur.2009.07.033
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发表时间：
2009-11-01
影响因子：
4.6
通讯作者：
Sack, Stefan
中科院分区：
文献类型：
--
作者：
Thielmann, Matthias;Wendt, Daniel;Sack, Stefan
背景。我们试图确定对于传统主动脉瓣置换术风险极高或极高、逻辑 EuroSCORE 大于 30% 或胸外科医生协会评分大于 15% 的患者，经导管主动脉瓣植入是否是合理的治疗选择。方法。 2005 年 5 月至 2008 年 11 月期间，85 例主动脉瓣置换术风险极高的经导管主动脉瓣植入患者中，有 39 例接受了经股动脉 (n = 15) 或经心尖 (n = 24) 经导管主动脉瓣植入，平均估计逻辑 EuroSCORE 为 44.2% +/- 12.6%（平均值 +/- 标准差），胸外科学会外科医生评分 17.9% +/- 6.1%。使用 Cribier-Edwards 或 Edwards SAPIEN 假体在混合手术室中进行经导管主动脉瓣植入。结果。 97% 的患者瓣膜植入成功。手术死亡率为 2.6%，30 天死亡率为 17.9%。瓣膜植入后，通过平均压力梯度降低（p < 0.001）和主动脉瓣面积增加（p < 0.001）以及纽约心脏协会功能状态的改善（p < 0.01）来评估血流动力学的改善。随访 3 个月、6 个月和 12 个月时精算生存率为 74.4%、74.4% 和 64.1%。超声心动图显示住院期间58%的患者存在主动脉瓣关闭不全，随访6个月时为43%，随访12个月时为40%，但在整个随访期间未观察到结构性瓣膜恶化。结论。对于严重主动脉瓣狭窄和主动脉瓣置换风险极高的患者，经导管主动脉瓣植入是可行的，并且可能是这些患者的合理治疗选择。 (Ann Thorac Surg 2009;88:1468-75) (C) 2009，胸外科医师协会
Background. We sought to determine whether transcatheter aortic valve implantation is a reasonable treatment option in patients with a very or extremely high risk for conventional aortic valve replacement, presenting with a logistic EuroSCORE greater than 30% or a Society of Thoracic Surgeons score greater than 15%.Methods. Between May 2005 and November 2008, 39 of 85 transcatheter aortic valve implantation patients with a very high risk for aortic valve replacement underwent either transfemoral (n = 15) or transapical (n = 24) transcatheter aortic valve implantation with a mean estimated logistic EuroSCORE of 44.2% +/- 12.6% (mean +/- standard deviation) and a Society of Thoracic Surgeons score of 17.9% +/- 6.1%. Transcatheter aortic valve implantation was performed in a hybrid operative theater using the Cribier-Edwards or Edwards SAPIEN prosthesis.Results. Valve implantation was successful in 97% of the patients. Operative mortality was 2.6%, and mortality at 30 days was 17.9%. After valve implantation, hemodynamic improvement was assessed by decreased mean pressure gradient (p < 0.001) and increased aortic valve area (p < 0.001), accompanied by improved New York Heart Association functional status (p < 0.01). Actuarial survival was 74.4% at 3 months, 74.4% at 6 months, and 64.1% at 12 months of follow-up. Echocardiography revealed aortic regurgitation in 58% of the patients during hospital stay, 43% at 6 months of follow-up, and 40% at 12 months of follow-up, but no structural valve deterioration could be observed during the complete follow-up period.Conclusions. Transcatheter aortic valve implantation in patients with severe aortic stenosis and a very high risk for aortic valve replacement is feasible and may be a reasonable treatment option in these patients. (Ann Thorac Surg 2009;88:1468-75) (C) 2009 by The Society of Thoracic Surgeons