Transcatheter Aortic Valve Replacement versus Sutureless Aortic Valve Replacement: A Single Center Retrospective Cohort Study

Yonsei Medical Journal 2021년 62권 10호 p.885 ~ p.894

정영학(Chung Young-Hak) - Yonsei University College of Medicine Severance Cardiovascular Hospital Division of Cardiology
이승현(Lee Seung-Hyun) - Yonsei University College of Medicine Severance Cardiovascular Hospital Department of Thoracic and Cardiovascular Surgery
고영국(Ko Young-Guk) - Yonsei University College of Medicine Severance Cardiovascular Hospital Division of Cardiology
이삭(Lee Sak) - Yonsei University College of Medicine Severance Cardiovascular Hospital Department of Thoracic and Cardiovascular Surgery
심지영(Shim Chi-Young) - Yonsei University College of Medicine Severance Cardiovascular Hospital Division of Cardiology
안철민(Ahn Chul-Min) - Yonsei University College of Medicine Severance Cardiovascular Hospital Division of Cardiology
홍그루(Hong Geu-Ru) - Yonsei University College of Medicine Severance Cardiovascular Hospital Division of Cardiology
심재광(Shim Jae-Kwang) - Yonsei University College of Medicine Severance Cardiovascular Hospital Department of Anesthesiology and Pain Medicine
곽영란(Kwak Young-Lan) - Yonsei University College of Medicine Severance Cardiovascular Hospital Department of Anesthesiology and Pain Medicine
홍명기(Hong Myeong-Ki) - Yonsei University College of Medicine Severance Cardiovascular Hospital Division of Cardiology

Abstract

Purpose: This study sought to compare clinical outcomes between transcatheter aortic valve replacement (TAVR) and sutureless aortic valve replacement (SU-AVR).

Materials and Methods: In total, 320 patients with symptomatic severe aortic stenosis who underwent TAVR (n=254) or SU-AVR (n=66) at Severance Cardiovascular Hospital between July 2011 and September 2019 were included for analysis. Propensity score matching and inverse probability weighted adjustment were performed to adjust for confounding baseline characteristics. Outcomes defined by the Valve Academic Research Consortium-2 in 62 patients pairs were compared.

Results: Device success (79.0% vs. 79.0%, p>0.999) and 30-day mortality (4.8% vs. 0.0%, p=0.244) did not differ between the TAVR and SU-AVR groups. The TAVR group developed more frequent mild or moderate paravalvular leakage (59.7% vs. 8.1%, p<0.001), whereas SU-AVR was associated with higher rates of major or life-threatening bleeding (9.7% vs. 22.6%, p=0.040), acute kidney injury (8.1% vs. 21.0%, p=0.041), and new-onset atrial fibrillation (4.8% vs. 32.3%. p<0.001) at 30 days, along with longer stays in the intensive care unit (ICU) (1.9±1.6 days vs. 5.9±9.2 days, p=0.009) and hospital (7.1±7.9 days vs. 13.1±8.8 days, p<0.001). The TAVR group showed a trend towards a higher 1-year all-cause mortality, compared with the SU-AVR group (7.0% vs 1.7%, p=0.149). Cardiovascular mortality, however, did not differ significantly (1.6% vs 1.7%, p=0.960).

Conclusion: TAVR achieved a similar 1-year survival rate free from cardiovascular mortality as SU-AVR and was associated with a lower incidence of complications, except for paravalvular leakage, and shorter stays in the ICU and hospital.

키워드

Aortic stenosis, transcatheter aortic valve replacement, sutureless aortic valve replacement, severe aortic stenosis
원문 및 링크아웃 정보
등재저널 정보
SCI(E) MEDLINE 학술진흥재단(KCI) KoreaMed 
주제코드
주제명(Target field)
연구대상(Population)
연구참여(Sample size)
대상성별(Gender)
질병특성(Condition Category)
연구환경(Setting)
연구설계(Study Design)
연구기간(Period)
중재방법(Intervention Type)
중재명칭(Intervention Name)
키워드(Keyword)
유효성결과(Recomendation)
30일 사망률 TAVR 그룹과 SU-AVR 그룹 간에 차이가 없었으나, TAVR은 증상이 있는 중증 AS 환자의 치료에 더 안전한 절차인 것으로 나타남[TAVR 그룹에서 더 빈번한 경증, 또는 중등도 판막주위 누출 발생(59.7% 대 8.1%, p<0.001)하였으나, SU-AVR은 더 높은 비율의 주요 또는 생명을 위협하는 출혈(9.7% 대 22.6%, p= 0.040), 30일에 급성 신장 손상(8.1% 대 21.0%, p=0.041) 및 새로 발병한 심방세동(4.8% 대 32.3%. p<0.001), 중환자실에서의 장기 체류 (ICU)(1.9±1.6일 대 5.9±9.2일, p=0.009) 및 병원(7.1±7.9일 대 13.1±8.8일, p<0.001) 관련이 있음]
연구비지원(Fund Source)
근거수준평가(Evidence Hierarchy)
출판년도(Year)
참여저자수(Authors)
대표저자
KCD코드
ICD 03
건강보험코드