Vittoria Lodo, Enrico G Italiano, Edoardo Zingarelli, Claudio Pietropaolo, Stefano Pidello, Gabriella Buono, Paolo Centofanti
{"title":"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。","authors":"Vittoria Lodo, Enrico G Italiano, Edoardo Zingarelli, Claudio Pietropaolo, Stefano Pidello, Gabriella Buono, Paolo Centofanti","doi":"10.26599/1671-5411.2024.09.005","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>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) <i>vs</i>. TAVI at our department.</p><p><strong>Methods: </strong>From September 2017 to December 2020, 673 consecutive patients with severe aortic valve stenosis were enrolled for AVR (<i>n</i> = 283) or TAVI (<i>n</i> = 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.</p><p><strong>Results: </strong>Four years survival is always superior in the AVR patients (89.8% <i>vs.</i> 75.6%, <i>P</i> < 0.001). Surgery is associated with a higher incidence of acute kidney injury (23% <i>vs.</i> 5.1%, <i>P</i> < 0.001), while TAVI is related to a higher incidence of new onset left bundle branch block (0 <i>vs.</i> 23.8%, <i>P</i> < 0.001), pace-maker implantation (2.5% <i>vs.</i> 11.8%, <i>P</i> = 0,02) and mild-to-moderate paravalvular leak (0.3% <i>vs.</i> 5.4%, <i>P</i> < 0.001). The independent risk factors for 4-years mortality are post-procedural AKI, poor mobility and transcatheter procedure.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":51294,"journal":{"name":"Journal of Geriatric Cardiology","volume":null,"pages":null},"PeriodicalIF":1.8000,"publicationDate":"2024-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11522709/pdf/","citationCount":"0","resultStr":"{\"title\":\"Transcatheter aortic valve implantation versus surgery: 4-year survival according to life expectancy.\",\"authors\":\"Vittoria Lodo, Enrico G Italiano, Edoardo Zingarelli, Claudio Pietropaolo, Stefano Pidello, Gabriella Buono, Paolo Centofanti\",\"doi\":\"10.26599/1671-5411.2024.09.005\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>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) <i>vs</i>. TAVI at our department.</p><p><strong>Methods: </strong>From September 2017 to December 2020, 673 consecutive patients with severe aortic valve stenosis were enrolled for AVR (<i>n</i> = 283) or TAVI (<i>n</i> = 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.</p><p><strong>Results: </strong>Four years survival is always superior in the AVR patients (89.8% <i>vs.</i> 75.6%, <i>P</i> < 0.001). Surgery is associated with a higher incidence of acute kidney injury (23% <i>vs.</i> 5.1%, <i>P</i> < 0.001), while TAVI is related to a higher incidence of new onset left bundle branch block (0 <i>vs.</i> 23.8%, <i>P</i> < 0.001), pace-maker implantation (2.5% <i>vs.</i> 11.8%, <i>P</i> = 0,02) and mild-to-moderate paravalvular leak (0.3% <i>vs.</i> 5.4%, <i>P</i> < 0.001). The independent risk factors for 4-years mortality are post-procedural AKI, poor mobility and transcatheter procedure.</p><p><strong>Conclusion: </strong>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. 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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。
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.
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.