不进行现场心脏手术是否可以进行TAVI ？

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

IJC Heart and Vasculature Pub Date : 2025-07-07 DOI:10.1016/j.ijcha.2025.101736

V. Lodo , C. Barbero , S. Salizzoni , E. Zingarelli , M.La Torre , Italiano G. Enrico , P. Centofanti , M. Rinaldi

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引用次数: 0

摘要

本分析的目的是评估经导管主动脉瓣植入术（TAVI）中手术救助的发生率和术后结果。方法2017年9月至2023年3月期间接受TAVI的患者从两个高容量中心入组。所有的手术都是在现场进行的，但尤其是在擦洗心脏外科医生。主要终点是急诊心脏手术（ECS）后TAVI患者的住院死亡率。次要终点是术中死亡率和1年死亡率，以及术后并发症，如急性肾损伤（AKI）、中风、心肌梗死（MI）、传导异常、肌力支持需求、重症监护病房（ICU）和住院时间。结果连续1347例患者行经股动脉TAVI。10例患者（0.74%）报告了术中并发症，需要ECS: 7例患者接受了自膨胀假体；3名患者接受了球囊式可膨胀假体。ECS的适应症包括：A型夹层（n = 2）、主动脉环破裂（n = 1）、左、右心室穿孔（n = 1）、二尖瓣损伤（n = 2）、假体栓塞（n = 2）。4例患者需要术后肌力支持。报告轻度脑卒中1例，急性肾损伤（III级）1例。3例患者术后出现左束支阻滞（LBBB）。ICU和住院时间的中位数分别为4.5（2-7.75）天和14（8-22）天。报告了一例住院死亡病例。结论现场心脏外科手术是TAVI中心在发生ECS时的救命资源，对实现低院内死亡率至关重要。

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Can TAVI be performed without on-site cardiac surgery?

Introduction

Aim of this analysis in to assess the prevalence and post-procedural outcomes of surgical bailout during transcatheter aortic valve implantation (TAVI).

Methods

Patients undergoing TAVI from September 2017 to March 2023 were enrolled from two high volume centers. All the procedures were performed with on-site cardiac surgery, but especially the scrubbed cardiac surgeon. The primary endpoint was in-hospital mortality of TAVI patients after emergent cardiac surgery (ECS). Secondary endpoints were intra-operative and 1-year mortality, and post-procedural complications such as acute kidney injury (AKI), stroke, myocardial infarction (MI), conduction abnormalities, need for inotropic support and intensive care unit (ICU) and in- hospital length of stay.

Results

A total of 1347 consecutive patients underwent transfemoral TAVI. Ten patients (0.74 %), representing the study population, reported intra-procedural complications requiring ECS: seven patients received a self-expandable prosthesis; three patients received a balloon expandable prosthesis. Indications for ECS included: type A dissection (n = 2), aortic annulus rupture (n = 1), left(n = 1) and right (n = 2) ventricle perforation, mitral valve apparatus damage (n = 2), prosthesis embolization (n = 2). Four patients required post-operative inotropic support. One case of minor stroke and one case of AKI (grade III) were reported. Three patients developed a post procedural left bundle branch block (LBBB). Median ICU and hospital length-of-stay were 4.5 (2–7.75) days and 14 (8–22) days, respectively. One case of in-hospital mortality was reported.

Conclusions

The on-site cardiac surgery, with the scrubbed heart surgeon, represents a life-saving resource for TAVI centers in case of ECS, and it is essential to achieve low-rate in-hospital mortality.

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来源期刊

IJC Heart and Vasculature Medicine-Cardiology and Cardiovascular Medicine

CiteScore

4.90

自引率

10.30%

发文量

216

审稿时长

56 days

期刊介绍： IJC Heart & Vasculature is an online-only, open-access journal dedicated to publishing original articles and reviews (also Editorials and Letters to the Editor) which report on structural and functional cardiovascular pathology, with an emphasis on imaging and disease pathophysiology. Articles must be authentic, educational, clinically relevant, and original in their content and scientific approach. IJC Heart & Vasculature requires the highest standards of scientific integrity in order to promote reliable, reproducible and verifiable research findings. All authors are advised to consult the Principles of Ethical Publishing in the International Journal of Cardiology before submitting a manuscript. Submission of a manuscript to this journal gives the publisher the right to publish that paper if it is accepted. Manuscripts may be edited to improve clarity and expression.