Minimum-incision transsubclavian transcatheter aortic valve replacement with balloon-expandable valve for dialysis patients

IF 2.5 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Journal of cardiology Pub Date : 2024-01-10 DOI:10.1016/j.jjcc.2024.01.001

Satoru Domoto MD, PhD , Junichi Yamaguchi MD, PhD, FJCC , Ken Tsuchiya MD, PhD , Yusuke Inagaki MD, PhD , Kosuke Nakamae MD , Masataka Hirota MD , Hiroyuki Arashi MD, PhD , Norio Hanafusa MD, PhD , Junichi Hoshino MD, PhD , Hiroshi Niinami MD, PhD

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Abstract

Background

Dialysis patients undergoing transcatheter aortic valve replacement (TAVR) face increased risk and have poorer outcomes than non-dialysis patients. Moreover, TAVR in dialysis patients using an alternative approach is considered extremely risky and little is known about the outcomes. We routinely perform minimum-incision transsubclavian TAVR (MITS-TAVR), which is contraindicated for transfemoral (TF) TAVR. This study aimed to evaluate the outcomes of MITS-TAVR compared with those of TF-TAVR in dialysis patients.

Methods

This single-center, observational study included 79 consecutive dialysis patients who underwent MITS-TAVR (MITS group, n = 22) or TF-TAVR (TF group, n = 57) under regional anesthesia.

Results

The rates of peripheral artery disease (MITS vs. TF, 72.7 % vs. 26.3 %; p < 0.01), shaggy aortas (MITS vs. TF, 63.6 % vs. 5.26 %; p < 0.01), and tortuous aortas (MITS vs. TF, 13.6 % vs. 1.75 %; p = 0.031) were significantly higher in the MITS group. The 30-day mortality was 2.53 % and comparable between the two groups (MITS vs. TF, 4.54 % vs. 1.75 %; p = 0.479). In the MITS group, 14 patients had ipsilateral dialysis fistulas, and three patients had patent in situ ipsilateral internal thoracic artery grafts; however, no vascular complications were observed. Kaplan–Meier survival curves for the two groups showed no significant difference in the survival rate (at 2 years; MITS vs. TF, 77.3 % vs. 68.8 %; p = 0.840) and freedom from cardiovascular mortality (at 2 years; MITS vs. TF, 90.9 % vs. 96.5 %; p = 0.898). The multivariable Cox proportional hazard model also indicated that survival in the MITS group was not significantly different from that in the TF group (hazard ratio 1.48; 95 % confidence interval, 0.77–2.85, p = 0.244). The patency rate of ipsilateral dialysis fistula was 100 % during follow-up.

Conclusion

The outcome of MITS-TAVR was comparable to that of TF-TAVR in dialysis patients, despite the higher risk of patient characteristics.

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为透析患者提供最小切口经锁骨下经导管主动脉瓣置换术（带球囊扩张瓣膜

背景与非透析患者相比，接受经导管主动脉瓣置换术（TAVR）的透析患者面临的风险更大，疗效更差。此外，在透析患者中使用替代方法进行 TAVR 被认为风险极高，其结果也鲜为人知。我们常规进行最小切口经锁骨下 TAVR（MITS-TAVR），而这是经口（TF）TAVR 的禁忌症。本研究旨在评估透析患者接受 MITS-TAVR 与 TF-TAVR 的疗效。方法这项单中心观察性研究纳入了 79 名连续透析患者，他们在区域麻醉下接受了 MITS-TAVR（MITS 组，n = 22）或 TF-TAVR（TF 组，n = 57）。结果 MITS 组的外周动脉疾病（MITS 组与 TF 组相比，72.7% 对 26.3%；P < 0.01）、主动脉畸形（MITS 组与 TF 组相比，63.6% 对 5.26%；P < 0.01）和主动脉迂曲（MITS 组与 TF 组相比，13.6% 对 1.75%；P = 0.031）发生率明显更高。30 天死亡率为 2.53%，两组死亡率相当（MITS 组比 TF 组，4.54% 比 1.75%；P = 0.479）。在 MITS 组中，14 名患者出现同侧透析瘘，3 名患者同侧胸内动脉移植物原位通畅，但未观察到血管并发症。两组患者的 Kaplan-Meier 生存曲线显示，生存率（2 年时；MITS vs. TF，77.3% vs. 68.8%；P = 0.840）和心血管死亡率（2 年时；MITS vs. TF，90.9% vs. 96.5%；P = 0.898）无显著差异。多变量考克斯比例危险模型也表明，MITS 组的存活率与 TF 组没有显著差异（危险比 1.48；95% 置信区间，0.77-2.85，p = 0.244）。结论在透析患者中，MITS-TAVR 的疗效与 TF-TAVR 相当，尽管患者的风险较高。

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来源期刊

Journal of cardiology CARDIAC & CARDIOVASCULAR SYSTEMS-

CiteScore

4.90

自引率

8.00%

发文量

202

审稿时长

29 days

期刊介绍： The official journal of the Japanese College of Cardiology is an international, English language, peer-reviewed journal publishing the latest findings in cardiovascular medicine. Journal of Cardiology (JC) aims to publish the highest-quality material covering original basic and clinical research on all aspects of cardiovascular disease. Topics covered include ischemic heart disease, cardiomyopathy, valvular heart disease, vascular disease, hypertension, arrhythmia, congenital heart disease, pharmacological and non-pharmacological treatment, new diagnostic techniques, and cardiovascular imaging. JC also publishes a selection of review articles, clinical trials, short communications, and important messages and letters to the editor.