经导管主动脉瓣植入术与手术:根据预期寿命计算的 4 年生存率。

IF 1.8 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS
Vittoria Lodo, Enrico G Italiano, Edoardo Zingarelli, Claudio Pietropaolo, Stefano Pidello, Gabriella Buono, Paolo Centofanti
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引用次数: 0

摘要

背景:近年来,经导管主动脉瓣植入术(TAVI)的适应症已扩展到更年轻和风险更低的患者。因此,人们对中长期随访和预期寿命的作用越来越感兴趣,而预期寿命是选择最合适治疗方法的关键因素。这项回顾性研究旨在比较在我院接受主动脉瓣置换术(AVR)与TAVI的患者的4年生存率:2017年9月至2020年12月,673名重度主动脉瓣狭窄患者连续接受了AVR(n = 283)或TAVI(n = 390)。纳入标准为孤立性重度主动脉瓣狭窄,排除标准为重做手术、瓣中瓣手术以及需要同时进行外科手术。根据 Lee 指数,患者按其 4 年预期寿命分为四组。采用 Kaplan-Meier 法评估并报告四年生存率。对4年死亡率的风险因素进行了多变量回归分析:结果:动静脉瓣膜置换术患者的四年生存率始终较高(89.8% 对 75.6%,P < 0.001)。手术与较高的急性肾损伤发生率相关(23% vs. 5.1%,P < 0.001),而TAVI与较高的新发左束支传导阻滞(0 vs. 23.8%,P < 0.001)、起搏器植入(2.5% vs. 11.8%,P = 0.02)和轻度至中度腔旁漏(0.3% vs. 5.4%,P < 0.001)发生率相关。4年死亡率的独立风险因素是术后AKI、活动能力差和经导管手术:结论:根据我们的分析,动静脉联合术患者的 4 年生存率始终较高。预期寿命是为每位患者选择最合适方法的关键因素。在将 TAVI 适应症扩展至预期寿命较长的患者之前,必须进行更长时间的随访。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Transcatheter aortic valve implantation versus surgery: 4-year survival according to life expectancy.

Background: In the last years, transcatheter aortic valve implantation (TAVI) indication has expanded to younger and lower risk patients. Consequently, interest in mid and long-term follow up and in the role of life expectancy, as a key factor for selecting the most tailored treatment, has grown. The aim of this retrospective study is to compare the 4-year survival of patients who underwent aortic valve replacement (AVR) vs. TAVI at our department.

Methods: From September 2017 to December 2020, 673 consecutive patients with severe aortic valve stenosis were enrolled for AVR (n = 283) or TAVI (n = 390). Inclusion criteria was isolated severe aortic stenosis, while exclusion criteria were redo surgery, valve-in-valve procedure and the need for concomitant surgical procedures. Based on the Lee index, patients were divided into four groups according to their 4-year life expectancy. Four-year survival was assessed and reported using the Kaplan-Meier method. A multivariate regression analysis of risk factors for 4-year mortality was performed.

Results: Four years survival is always superior in the AVR patients (89.8% vs. 75.6%, P < 0.001). Surgery is associated with a higher incidence of acute kidney injury (23% vs. 5.1%, P < 0.001), while TAVI is related to a higher incidence of new onset left bundle branch block (0 vs. 23.8%, P < 0.001), pace-maker implantation (2.5% vs. 11.8%, P = 0,02) and mild-to-moderate paravalvular leak (0.3% vs. 5.4%, P < 0.001). The independent risk factors for 4-years mortality are post-procedural AKI, poor mobility and transcatheter procedure.

Conclusion: In our analysis, 4 years survival is always superior in the AVR patients. Life expectancy is a key factor for selecting the most appropriate approach for each patient. A longer follow up is mandatory before extending TAVI indication to patients with a long-life expectancy.

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来源期刊
Journal of Geriatric Cardiology
Journal of Geriatric Cardiology CARDIAC & CARDIOVASCULAR SYSTEMS-GERIATRICS & GERONTOLOGY
CiteScore
3.30
自引率
4.00%
发文量
1161
期刊介绍: JGC focuses on both basic research and clinical practice to the diagnosis and treatment of cardiovascular disease in the aged people, especially those with concomitant disease of other major organ-systems, such as the lungs, the kidneys, liver, central nervous system, gastrointestinal tract or endocrinology, etc.
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