低风险时代年轻患者接受球囊扩张经导管主动脉瓣置换术的疗效。

IF 14.8 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS
Megan Coylewright, Kendra J Grubb, Suzanne V Arnold, Wayne Batchelor, Abhijeet Dhoble, Aaron Horne, Martin B Leon, Vinod Thourani, Tamim M Nazif, Brian R Lindman, Molly Szerlip
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引用次数: 0

摘要

重要性:指南建议心脏团队对所有主动脉瓣狭窄患者进行评估,建议 65 岁以下或预期寿命超过 20 年的患者进行主动脉瓣置换手术。如果选择生物人工瓣膜,由于组织瓣膜的耐久性有限,可能需要重复手术;然而,年轻的主动脉瓣狭窄患者可能有严重的合并症,会限制预期寿命,从而影响决策:目的:描述接受经导管主动脉瓣置换术(TAVR)的65岁以下患者的特征,并将他们的治疗结果与65至80岁的患者进行比较:这项基于注册表的回顾性分析使用了胸外科医师协会/美国心脏病学会经导管瓣膜治疗(TVT)注册表中139 695名患者的数据,包括2019年8月至2023年9月期间接受TAVR的80岁及以下患者:干预措施:使用 SAPIEN 系列设备进行球囊扩张瓣膜 (BEV) TAVR:与65至80岁的患者相比,65岁以下患者的合并症(心衰、冠心病、透析等)和结局(死亡、中风和再入院):在调查的年份中,13 849 名登记患者(5.7%)小于 65 岁,125 846 名(52.1%)65 至 80 岁,101 725 名(42.1%)80 岁及以上。在 65 岁以下的患者中,平均年龄(标准差)为 59.7(4.8)岁,13 849 名患者中有 9068 名男性(65.5%)。在 65 至 80 岁的患者中,平均年龄(标准差)为 74.1 (4.2)岁,125 843 名患者中有 77 817 名男性(61.8%)。与 65 至 80 岁的患者相比,65 岁以下的患者更有可能患有主动脉瓣二尖瓣(分别为 3472/13 755 [25.2%] vs 9552/125 001 [7.6%];P 结论及意义:在低手术风险时代,接受 BEV TAVR 治疗重度主动脉瓣狭窄的美国患者中,65 岁以下的患者只占一小部分。与年龄较大的患者相比,65 岁以下的患者合并症较多,1 年后的死亡率和再入院率较高。这些观察结果表明,心脏团队对这一年龄组的大多数患者进行 TAVR 的决策在临床上是有效的。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Outcomes of Balloon-Expandable Transcatheter Aortic Valve Replacement in Younger Patients in the Low-Risk Era.

Importance: Guidelines advise heart team assessment for all patients with aortic stenosis, with surgical aortic valve replacement recommended for patients younger than 65 years or with a life expectancy greater than 20 years. If bioprosthetic valves are selected, repeat procedures may be needed given limited durability of tissue valves; however, younger patients with aortic stenosis may have major comorbidities that can limit life expectancy, impacting decision-making.

Objective: To characterize patients younger than 65 years who received transcatheter aortic valve replacement (TAVR) and compare their outcomes with patients aged 65 to 80 years.

Design, setting, and participants: This retrospective registry-based analysis used data on 139 695 patients from the Society for Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy (TVT) Registry, inclusive of patients 80 years and younger undergoing TAVR from August 2019 to September 2023.

Intervention: Balloon-expandable valve (BEV) TAVR with the SAPIEN family of devices.

Main outcomes and measures: Comorbidities (heart failure, coronary artery disease, dialysis, and others) and outcomes (death, stroke, and hospital readmission) of patients younger than 65 years compared to patients aged 65 to 80 years.

Results: In the years surveyed, 13 849 registry patients (5.7%) were younger than 65 years, 125 846 (52.1%) were aged 65 to 80 years, and 101 725 (42.1%) were 80 years and older. Among those younger than 65, the mean (SD) age was 59.7 (4.8) years, and 9068 of 13 849 patients (65.5%) were male. Among those aged 65 to 80 years, the mean (SD) age was 74.1 (4.2) years, and 77 817 of 125 843 patients (61.8%) were male. Those younger than 65 years were more likely to have a bicuspid aortic valve than those aged 65 to 80 years (3472/13 755 [25.2%] vs 9552/125 001 [7.6%], respectively; P < .001). They were more likely to have congestive heart failure, chronic lung disease, diabetes, immunocompromise, and end stage kidney disease receiving dialysis. Patients younger than 65 years had worse baseline quality of life (mean [SD] Kansas City Cardiomyopathy Questionnaire score, 47.7 [26.3] vs 52.9 [25.8], respectively; P < .001) and mean (SD) gait speed (5-meter walk test, 6.6 [5.8] seconds vs 7.0 [4.9] seconds, respectively; P < .001) than those aged 65 to 80 years. At 1 year, patients younger than 65 years had significantly higher readmission rates (2740 [28.2%] vs 23 178 [26.1%]; P < .001) and all-cause mortality (908 [9.9%] vs 6877 [8.2%]; P < .001) than older patients. When propensity matched, younger patients still had higher 1-year readmission rates (2732 [28.2%] vs 2589 [26.8%]; P < .03) with similar mortality to their older counterparts (905 [9.9%] vs 827 [10.1%]; P = .55).

Conclusions and relevance: Among US patients receiving BEV TAVR for severe aortic stenosis in the low-surgical risk era, those younger than 65 years represent a small subset. Patients younger than 65 years had a high burden of comorbidities and incurred higher rates of death and readmission at 1 year compared to their older counterparts. These observations suggest that heart team decision-making regarding TAVR for most patients in this age group is clinically valid.

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来源期刊
JAMA cardiology
JAMA cardiology Medicine-Cardiology and Cardiovascular Medicine
CiteScore
45.80
自引率
1.70%
发文量
264
期刊介绍: JAMA Cardiology, an international peer-reviewed journal, serves as the premier publication for clinical investigators, clinicians, and trainees in cardiovascular medicine worldwide. As a member of the JAMA Network, it aligns with a consortium of peer-reviewed general medical and specialty publications. Published online weekly, every Wednesday, and in 12 print/online issues annually, JAMA Cardiology attracts over 4.3 million annual article views and downloads. Research articles become freely accessible online 12 months post-publication without any author fees. Moreover, the online version is readily accessible to institutions in developing countries through the World Health Organization's HINARI program. Positioned at the intersection of clinical investigation, actionable clinical science, and clinical practice, JAMA Cardiology prioritizes traditional and evolving cardiovascular medicine, alongside evidence-based health policy. It places particular emphasis on health equity, especially when grounded in original science, as a top editorial priority.
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