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Contemporary short-term outcomes of surgery for aortic stenosis: transcatheter vs. surgical aortic valve replacement.
General Thoracic and Cardiovascular Surgery ( IF 1.1 ) Pub Date : 2021-06-22 , DOI: 10.1007/s11748-021-01672-8
Shunsuke Saito 1 , Toshimi Sairenchi 2 , Masahiro Tezuka 1 , Yusuke Takei 1 , Go Tsuchiya 1 , Koji Ogata 1 , Osamu Monta 3 , Ikuko Shibasaki 1 , Yasushi Tsutsumi 3 , Hirotsugu Fukuda 1
Affiliation  

OBJECTIVES This study aimed to compare the short-term outcomes of transcatheter and surgical aortic valve replacements (TAVR and SAVR) in high-, intermediate-, and low-preoperative risk patients. METHODS A total of 454 patients who underwent TAVR or SAVR were included. Patients were categorized into high-, intermediate-, and low-risk according to the Society of Thoracic Surgery-Predicted Risk of Mortality score and clinical outcomes were compared between TAVR and SAVR groups. RESULTS TAVR was less invasive, with less bleeding and transfusion (p < 0.001), less frequent new-onset atrial fibrillation (p < 0.001), and shorter intensive care unit stay (p < 0.001). Furthermore, transcatheter valves performed better than surgical valves, with lower peak velocity (p = 0.003) and pressure gradient (p < 0.001) and higher effective orifice area index (p < 0.001). The clinical outcomes of TAVR were comparable to or even superior to those of SAVR in high- and intermediate-risk patients. In low-risk patients, the 1- and 2-year mortality rates were 6.3% and 12.1%, respectively, in the TAVR group and 0% and 0.9%, respectively, in the SAVR group (p < 0.001). Mild or greater paravalvular leakage was a risk factor for mortality (hazard ratio 35.78; p < 0.001). CONCLUSIONS TAVR was superior to SAVR in the sense of less invasiveness and valvular function. However, the indication of TAVR in low-risk patients should be carefully discussed, because paravalvular leakage was a risk factor for short-term mortality.

中文翻译:

主动脉瓣狭窄手术的当代短期结果:经导管与手术主动脉瓣置换术。

目的 本研究旨在比较经导管和外科主动脉瓣置换术(TAVR 和 SAVR)在高、中、低术前风险患者中的短期结果。方法 共纳入 454 例接受 TAVR 或 SAVR 的患者。根据胸外科学会预测的死亡风险评分将患者分为高危、中危和低危,并对 TAVR 和 SAVR 组的临床结果进行比较。结果 TAVR 侵入性较小,出血和输血较少 (p < 0.001),新发心房颤动的频率较低 (p < 0.001),重症监护病房停留时间较短 (p < 0.001)。此外,经导管瓣膜的性能优于手术瓣膜,峰值速度 (p = 0.003) 和压力梯度 (p < 0. 001) 和更高的有效孔口面积指数 (p < 0.001)。在高危和中危患者中,TAVR 的临床结果与 SAVR 相当,甚至更胜一筹。在低风险患者中,TAVR 组的 1 年和 2 年死亡率分别为 6.3% 和 12.1%,SAVR 组分别为 0% 和 0.9%(p < 0.001)。轻度或更大程度的瓣周漏是死亡的危险因素(风险比 35.78;p < 0.001)。结论 TAVR 在侵入性和瓣膜功能方面优于 SAVR。然而,应仔细讨论低危患者的 TAVR 指征,因为瓣周漏是短期死亡率的危险因素。在高危和中危患者中,TAVR 的临床结果与 SAVR 相当,甚至更胜一筹。在低风险患者中,TAVR 组的 1 年和 2 年死亡率分别为 6.3% 和 12.1%,SAVR 组分别为 0% 和 0.9%(p < 0.001)。轻度或更大程度的瓣周漏是死亡的危险因素(风险比 35.78;p < 0.001)。结论 TAVR 在侵入性和瓣膜功能方面优于 SAVR。然而,应仔细讨论低危患者的 TAVR 指征,因为瓣周漏是短期死亡率的危险因素。在高危和中危患者中,TAVR 的临床结果与 SAVR 相当,甚至更胜一筹。在低风险患者中,TAVR 组的 1 年和 2 年死亡率分别为 6.3% 和 12.1%,SAVR 组分别为 0% 和 0.9%(p < 0.001)。轻度或更大程度的瓣周漏是死亡的危险因素(风险比 35.78;p < 0.001)。结论 TAVR 在侵入性和瓣膜功能方面优于 SAVR。然而,应仔细讨论低危患者的 TAVR 指征,因为瓣周漏是短期死亡率的危险因素。轻度或更大程度的瓣周漏是死亡的危险因素(风险比 35.78;p < 0.001)。结论 TAVR 在侵入性和瓣膜功能方面优于 SAVR。然而,应仔细讨论低危患者的 TAVR 指征,因为瓣周漏是短期死亡率的危险因素。轻度或更大程度的瓣周漏是死亡的危险因素(风险比 35.78;p < 0.001)。结论 TAVR 在侵入性和瓣膜功能方面优于 SAVR。然而,应仔细讨论低危患者的 TAVR 指征,因为瓣周漏是短期死亡率的危险因素。
更新日期:2021-06-22
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