Outcomes of intermediate-risk patients treated with transcatheter and surgical aortic valve replacement in the Veterans Affairs Healthcare System: A single center 20-year experience.
Outcomes of intermediate-risk patients treated with transcatheter and surgical aortic valve replacement in the Veterans Affairs Healthcare System: A single center 20-year experience.
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DOI：
10.1002/ccd.27478
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发表时间：
2018-08-01
期刊：
影响因子：
--
通讯作者：
Adabag S
中科院分区：
文献类型：
--
作者：
Garcia S;Kelly R;Mbai M;Gurevich S;Oestreich B;Yannopoulos D;Adabag S
经股动脉瓣膜置换术(TAVR)优于外科主动脉瓣置换术(SAVR)(P2)。试验结果对更广泛的中等手术风险患者群体的普适性尚不清楚。比较在VA医疗系统中接受中等手术风险患者的SAVR和TAVR的结果。我们回顾分析了在明尼阿波利斯VA医疗系统进行的所有SAVR(1987-2014)和TAVR(2015-2017)手术的临床特征和结果。根据估计的30天死亡风险，患者被分为三组。主要结果是30天后死亡或中风的综合结果。在研究期间，共有1,049名患者接受了SAVR(n=468，45%)或非CABG(n=581，55%)，110名患者接受了TAVR。中危患者分别占接受SAVR和TAVR患者的29.4%和40%。SAVR组和TAVR组中等风险患者30天的预计死亡风险分别为5.5%和5.2%(p=0.54)。在接受SAVR和TAVR治疗的中等风险患者中，观察到的30天内中风或死亡的综合发生率分别为11%和2.2%(p=0.05)。VA时SAVR和TAVR的结果与P2试验和STS数据库相似(均p=NS)。当分析局限于更当代(2005-2014)的外科队列或孤立的SAVR时，结果没有改变。用TAVR预防一例死亡/中风所需的治疗数量为10例。采用TAVR作为中危患者的首选治疗方式可能会显著改善发病率和死亡率。
Transfemoral Transcatheter Aortic Valve Replacement (TAVR) was superior to surgical aortic valve replacement (SAVR) in the Placement of Aortic Transcatheter Valves (PARTNER) 2A trial (P2). The generalizability of the trial results to the broader population of patients with intermediate surgical risk remains unknown. To compare the outcomes of SAVR and TAVR among patients with intermediate surgical risk treated in the VA Healthcare System. We retrospectively analyzed the clinical characteristics and outcomes on all SAVR (1987–2014) and TAVR procedures (2015–2017) performed at the Minneapolis VA Healthcare System. Patients were divided into three groups based on their estimated 30-day mortality risk. The primary outcome was a composite of death or stroke at 30-days. A total of 1,049 patients underwent SAVR with (n=468, 45%) or without CABG (n=581, 55%) and 110 underwent TAVR during the study period. Intermediate-risk patients represented 29.4% and 40% of patients undergoing SAVR and TAVR, respectively. The predicted 30-day mortality risk of intermediate-risk patients was 5.5% for the SAVR group and 5.2% for the TAVR group (p=0.54). The observed combined rate of stroke or death at 30-days for intermediate-risk patients treated with SAVR and TAVR was 11% and 2.2%, respectively (p=0.05). The results for SAVR and TAVR at the VA were comparable to the P2 trial and STS database (all p=NS). The results did not change when the analysis was restricted to a more contemporary (2005–2014) surgical cohort or isolated SAVR. The number needed to treat to prevent one death/stroke with TAVR was 10. Adoption of TAVR as the preferred treatment modality in intermediate-risk patients may result in significant improvements in morbidity and mortality.
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影响因子：
4.6
作者：
Grover, FL;Shroyer, ALW;Hammermeister, KE
通讯作者：
Hammermeister, KE
影响因子：
4.6
作者：
GROVER, FL;JOHNSON, RR;HAMMERMEISTER, KE
通讯作者：
HAMMERMEISTER, KE
影响因子：
158.5
作者：
Leon, Martin B.;Smith, Craig R.;Pocock, Stuart
通讯作者：
Pocock, Stuart
影响因子：
168.9
作者：
Keeley, EC;Boura, JA;Grines, CL
通讯作者：
Grines, CL
影响因子：
158.5
作者：
Smith, Craig R.;Leon, Martin B.;Pocock, Stuart J.
通讯作者：
Pocock, Stuart J.