Preliminary evaluation on the efficacy of emergency transcatheter aortic valve replacement: a multicenter study.
10.3760/cma.j.cn112148-20220601-00434
- Author:
Zheng ZHOU
1
;
Long Yan ZHANG
2
;
Jian YANG
3
;
Xiao Ke SHANG
4
;
Jie LI
5
;
Wen Zhi PAN
6
;
Zheng Ming JIANG
7
;
Zhen Fei FANG
8
;
Fei LI
9
;
Yong Jian WU
1
;
Guang Yuan SONG
1
Author Information
1. Division of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China.
2. Division of Cardiology, Wuhan Asia Heart Hospital, Wuhan 430022, China.
3. Department of Cardiac Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an 710032, China.
4. Department of Cardiac Surgery, Union Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology, Wuhan 430022, China.
5. Division of Cardiology, Guangdong Provincial People's Hospital, Guangzhou 510000, China.
6. Division of Cardiology, Zhongshan Hospital Affiliated to Fudan University, Shanghai 200032, China.
7. Division of Cardiology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China.
8. Division of Cardiology, the Second Xiangya Hospital of Central South University, Changsha 410011, China.
9. Division of Cardiology, Xijing Hospital, Fourth Military Medical University, Xi'an 710032, China.
- Publication Type:Multicenter Study
- MeSH:
Acute Kidney Injury;
Aged;
Aged, 80 and over;
Aortic Valve/surgery*;
Aortic Valve Stenosis/surgery*;
Female;
Heart Valve Prosthesis;
Humans;
Male;
Middle Aged;
Myocardial Infarction/surgery*;
Retrospective Studies;
Risk Factors;
Stroke;
Stroke Volume;
Transcatheter Aortic Valve Replacement/methods*;
Treatment Outcome;
Ventricular Function, Left
- From:
Chinese Journal of Cardiology
2022;50(7):698-704
- CountryChina
- Language:Chinese
-
Abstract:
Objectives: To explore the efficacy and safety of emergency transcatheter aortic valve replacement (TAVR). Methods: Data of patients who underwent emergency TAVR in eight centers, namely Fuwai Hospital, Wuhan Asia Heart Hospital, Xijing Hospital, Union Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology, Guangdong Provincial People's Hospital, Zhongshan Hospital Affiliated to Fudan University, the First Affiliated Hospital of Zhengzhou University, the Second Xiangya Hospital of Central South University, between May 2017 and December 2020 were retrospectively analyzed. The use of mechanical circulatory support system (MCS) and the results of laboratory tests (N-terminal B-type natriuretic peptide (NT-proBNP)) and echocardiography (mean aortic valve cross valve pressure difference and left ventricular ejection fraction) before and after operation were collected. The primary endpoint was all-cause death, and the secondary endpoints were stroke, major bleeding, major vascular complications, myocardial infarction, permanent pacemaker implantation, and acute renal injury. Device success was caculated, which refered to absence of procedural mortality and correct positioning of a single prosthetic heart valve into the proper anatomical location and intended performance of the prosthetic heart valve (mean aortic valve gradient<20 mmHg(1 mmHg=0.133 kPa) or peak velocity<3 m/s, with no moderate or severe prosthetic valve regurgitation). Kaplan-Meier survival curve was used to estimate the survival rate of patients during follow-up. Results: This study included 48 patients. The age was (72.5±8.1) years, and 34 patients were males (70.8%). Device success rate was 91.7% (44/48). The mean aortic valve transvalvular pressure was significantly decreased after operation ((12.3±6.4)mmHg vs. (60.2±23.8)mmHg, P<0.000 1). Left ventricular ejection fraction was significantly increased ((41.5±11.7)% vs. (31.0±11.3)%, P<0.000 1). NT-proBNP significantly decreased (3 492.0 (1 638.8, 7 165.5) ng/L vs. 12 418.5 (6 693.8, 35 000.0) ng/L, P<0.000 1). In-hospital all-cause mortality was 8.3% (4/48). During hospitalization, the rate of stroke was 2.1% (1/48), major bleeding was 6.3% (3/48), major vascular complications was 10.4% (5/48), myocardial infarction was 4.2% (2/48), permanent pacemaker implantation was 6.3% (3/48), and the rate of acute renal injury was 12.5% (6/48). MCS was used in 20 patients (41.7%). The median follow-up time was 196 days. During the follow-up, one patient died (due to systemic metastasis of pancreatic cancer), two cases suffered new myocardial infarction and one case received permanent pacemaker implantation. The survival rate of 30 days, 1 year and 2 years after the operation were 91.7% (44/48), 89.6% (43/48), 89.6% (43/48), respectively. Conclusion: Emergency TAVR may be a safe and effective treatment for patients with severe decompensated aortic valve stenosis.
