Patients younger than 70 undergoing transcatheter aortic valve implantation: Procedural outcomes and mid-term survival

Introduction: Based on recent data, the indication for transcatheter aortic valve implantation (TAVI) is expanding to individuals at lower surgical risk, who are generally younger than subjects historically treated for severe aortic stenosis. Indeed, younger patients have traditionally been under-represented in current TAVI literature. The aim of the present study is to report about clinical features, procedural outcomes and mid-term outcomes of patients younger than 70 who underwent TAVI in a single high-volume center. Materials and methods: Consecutive patients younger than 70 years of age who underwent TAVI for severe, symptomatic aortic stenosis between 2007 and 2019 at a single, tertiary referral center have been included in this retrospective study. Procedural and mid-term outcomes were analyzed, comparing 1st generation with 2nd generation devices. Results: Between 2007 and 2019, 1740 TAVI procedures were performed in our center. Among these, one hundred twenty-nine (7.4%) patients were younger than 70 years at the time of the intervention and were included in the present analysis. Fifty-eight patients (45%) were implanted with a 1st generation prosthesis while seventy-one patients (55%) were implanted with a 2nd generation device. Reasons which lead to a transcatheter approach in this population were: previous CABG (27.9%); porcelain aorta (24%); severe left ventricular systolic dysfunction (21.7%); prior chest radiation (19.4%); severe lung disease (8.5%); hemodynamic instability (7.0%); advanced liver disease (4.6%) and active cancer (3.9%). Overall device success rate was 89%, with no differences among 1st and 2nd generation devices. Threeyears all-cause mortality was 34%, with no difference among the two groups. Low incidence of aortic-valve re-intervention was observed at mid-term follow-up (late valve re-intervention = 2.3%). Conclusions: TAVI in young patient with appropriate indication for intervention is a safe procedure, associated with low rate of in hospital mortality and low rate of severe complications both with 1st and with 2nd generation devices. When considering long term durability, more data are needed; in our case series long-term follow up shows a good survival and also an extremely low rate of valve re-intervention. doi: 10.1016/j.ijcha.2021.100817.引言：基于近期研究数据，经导管主动脉瓣植入术（transcatheter aortic valve implantation, TAVI）的适应证正逐步拓展至手术风险较低的人群，这类人群通常较既往接受重度主动脉瓣狭窄治疗的患者更为年轻。事实上，年轻患者在当前TAVI相关研究文献中历来占比不足。本研究旨在报告单中心高流量医疗中心内，接受TAVI治疗的70岁以下患者的临床特征、手术结局及中期结局。 材料与方法：本回顾性研究纳入2007年至2019年间，于单中心三级转诊中心因有症状重度主动脉瓣狭窄接受TAVI治疗的70岁以下连续入组患者。本研究对手术结局与中期结局进行分析，并对比第一代与第二代瓣膜装置的应用效果。 结果：2007年至2019年间，本中心共完成1740例TAVI手术。其中，129例（7.4%）患者于手术时年龄不足70岁，纳入本研究分析。58例（45%）患者植入第一代瓣膜假体，71例（55%）患者植入第二代瓣膜装置。本队列患者选择经导管治疗的原因包括：既往冠状动脉旁路移植术（Coronary Artery Bypass Grafting, CABG）史（27.9%）、瓷化主动脉（porcelain aorta）（24%）、重度左心室收缩功能不全（left ventricular systolic dysfunction）（21.7%）、既往胸部放疗史（19.4%）、重度肺部疾病（8.5%）、血流动力学不稳定（hemodynamic instability）（7.0%）、晚期肝病（advanced liver disease）（4.6%）及活动性恶性肿瘤（active cancer）（3.9%）。整体手术成功率为89%，第一代与第二代装置间无显著差异。术后3年全因死亡率为34%，两组间无显著差异。中期随访期间，主动脉瓣再干预发生率较低（晚期瓣膜再干预率为2.3%）。 结论：对于具备恰当手术适应证的年轻患者，TAVI是一项安全的治疗手段，无论使用第一代还是第二代瓣膜装置，其住院死亡率与严重并发症发生率均较低。关于长期耐用性，仍需更多研究数据支持；本病例系列的长期随访结果显示，患者生存率良好，且瓣膜再干预率极低。 doi: 10.1016/j.ijcha.2021.100817.