重度主动脉瓣狭窄患者经股动脉主动脉瓣膜置换术后预后的性别差异分析

Analysis of gender differences in prognosis after transfemoral transcatheter aortic valve replacement in patients with severe aortic stenosis

目的探讨重度主动脉瓣狭窄(AS)患者经股动脉主动脉瓣膜置换术(TAVR)后预后的性别差异。方法本研究为单中心回顾性研究,连续纳入2016年1月至2020年7月在武汉亚洲心脏病医院行TAVR治疗的患者共111例,入选86例患者进行分析,按照性别分为两组,其中男性组54例,女性组32例,比较两组间基线资料、术前超声心动图特征、手术过程资料和临床预后,主要终点为术后30 d和1年随访期内全因死亡率,次要终点为院内和术后30 d手术并发症发生率。结果女性组体表面积、股动脉动脉鞘和置入瓣膜直径更小,主动脉瓣平均跨瓣压差更高;男性组近期吸烟(<1年)、冠心病和球囊后扩张的比例更高。两组间院内和术后30 d的次要终点,包括血管并发症、出血事件、卒中、置入永久起搏器、中度及以上瓣周漏、急性肾损伤发生率差异均无统计学意义(P>0.05)。两组均未发生心肌梗死。两组术后30 d死亡患者共3例,其中男性组心力衰竭合并多脏器功能衰竭1例,心源性休克1例,女性组心脏原因死亡1例(具体不详);术后1年新增死亡患者4例,其中多脏器功能衰竭1例,呼吸衰竭1例,死亡原因不详2例,均在男性组。术后30 d和1年的全因死亡率差异无统计学意义;Kaplan-Meier曲线显示,两组1年的全因死亡率差异无统计学意义(P>0.05)。结论重度AS患者经股动脉TAVR治疗在不同性别之间预后相似。

Objective To investigate the gender difference in the prognosis after transfemoral transcatheter aortic valve replacement(TAVR) in patients with severe aortic stenosis(AS). Methods A total of 111 patients who received TAVR treatment in Asia Heart Hospital, Wuhan from January 2016 to July 2020 were continuously involved in this study and 86 patients were involved for the analysis. They were divided into two groups according to gender, involving 54 male and 32 female. The baseline data, preoperative echocardiographic characteristics,surgical procedure data and clinical outcomes were compared between the two groups. The primary end points were all-cause mortality 30 days after procedure and 1-year follow-up;and the secondary endpoints were the incidence of surgical complications in hospital and 30 days after procedure. Results The female group had smaller body surface area, femoral artery sheath and implanted valve diameter as well as higher mean transvalvular gradient of the aortic valve;the male group had higher proportion of recent smoking(<1 year), coronary heart disease, and post-balloon dilatation. There were no significant differences in the secondary endpoints, involving vascular complications, bleeding events, stroke, permanent pacemaker placement, moderate or greater paravalvular leakage, and acute kidney injury between the two groups(P>0.05) and no myocardial infarction occurred in both the two groups. A total of 3 patients died 30 days after the surgery in the two groups, including1 from heart failure combined with multiple organ failure, 1 from cardiogenic shock and 1 patient in the female group who died of cardiac causes(details unknown). 1 year after the procedure, 4 patients died, including 1 from multiple organ failure, 1 from respiratory failure and 2 from unknown causes, all in the male group. There was no significant difference in all-cause mortality from 30 days and 1 year after the procedure. The Kaplan-Meier curve showed that there was no significant difference in 1-year all-cause mortality between the two groups(P>0.05). Conclusion The outcome of femoral artery TAVR treatment in patients with severe AS is similar in different genders.