Clinical practice and prognosis of emergent transcatheter aortic valve replacement
10.3760/cma.j.issn.1671-0282.2022.03.019
- VernacularTitle:急诊经导管主动脉瓣置换术临床实践及预后分析
- Author:
Dao ZHOU
1
;
Xianbao LIU
;
Jiaqi FAN
;
Lihan WANG
;
Po HU
;
Jubo JIANG
;
Zhaoxia PU
;
Xinping LIN
;
Huajun LI
;
Hanyi DAI
;
Gangjie ZHU
;
Yeming XU
;
Jian’an WANG
Author Information
1. 浙江大学医学院附属第二医院心内科，杭州 310009
- Keywords:
Severe aortic stenosis;
Emergent treatment;
Transcatheter aortic valve replacement
- From:
Chinese Journal of Emergency Medicine
2022;31(3):368-373
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To evaluate the effectiveness and prognosis of emergent transcatheter aortic valve replacement (TAVR) and to provide standardized procedural suggestion for the development of emergent TAVR in China.Methods:From January 2020 to April 2021, 12 patients who underwent emergent or salvage TAVR in the Second Affiliated Hospital Zhejiang University School of Medicine were retrospectively enrolled from the TORCH registry (Transcatheter Aortic Valve Replacement Single Center Registry in Chinese Population, a prospective cohort study; NCT02803294). Baseline, periprocedural and 30-day follow up data were collected. Post-operative data were compared with pre-operative data using Paired-Samples test.Results:Patients’ median Society of Thoracic Surgeons score (STS score) was 15.432%. There was a significant decrease of mean gradient after emergent TAVR procedure (1.69 m/s vs. 4.90 m/s, P<0.01). During the 30-day follow up, there were 1 patient (8.3%) died and 2 patients received permanent pacemaker implantation. No disabling stroke, acute kidney injury, major vascular complication occurred during the first month after emergent TAVR. Among the survival patients, there was a significant releasing of heart failure symptoms to New York Heart Association function stage Ⅰ/Ⅱ in 81.8% patients at 30-day follow up. Left ventricular ejection fraction also improved significantly from (47.4±9.5)% to 58.8±8.0% ( P= 0.026). The mean gradient were (1.57±0.30) cm 2 and no patients had a moderate or severe paravalvular leakage. Besides, a significant decrease of pro-B-type natriuretic peptide (1 089.9 pg/mL vs. 12 215.5 pg/mL , P=0.001) and troponin T (0.020 ng/mL vs. 0.337 ng/mL, P=0.003) were found at 30 days after emergent TAVR. Conclusions:For patients with severe aortic stenosis and acute cardiac decompensated, emergent TAVR is a safe and effective rescue treatment.
