| Abstract | CILJ: Prikazati osnovne kliničke karakteristike i komorbiditete pacijenata s teškom stenozom aortnog zalistka te utvrditi razlike između onih liječenih klasičnom operacijom (SAVR) i transkateterskom implantacijom zalistka (TAVI) tijekom 2021.godine u KBC Split.
ISPITANICI I POSTUPCI: U ovo retrospektivno istraživanje je ukupno uključeno 144 pacijenta od kojih je 93 bilo podvrgnuto TAVI-ju, a 51 SAVR-u. Analizirani su dob, spol, EuroSCORE II, NYHA stadij, komorbiditeti, srčana premosnica, perkutana koronarna intervencija, laboratorijski parametri, dani hospitalizacije te ultrazvučni parametri. Podatci su unijeti u program Microsoft Excel te statistički analizirani u R v3.2.2 programu.
REZULTATI: Od ukupno 144 pacijenta hospitalizirana pod dijagnozom teške aortne stenoze, 93 (65%) bilo podvrgnuto TAVI-ju, a 51 (35%) SAVR-u. U obje skupine su prevladavali muškarci, u skupini TAVI 56%, a u SAVR skupini 69% pacijenata. Osnovni demografski, anamnestički, laboratorijski te ehokardiografski parametri u odnosu na urađeni zahvat pokazuju da su TAVI pacijenti stariji, imaju slabiju bubrežnu funkciju te više komorbiditeta. Dokazana je statistički značajna razlika u danima hospitalizacije bolesnika (P<0,001; medijan TAVI 4 dana, SAVR 19 dana). Među TAVI bolesnicima veći broj prethodnih kardiokirurških revaskularizacija (CABG) je bio u mlađoj dobnoj skupini ≤75 godina (P=0,033). Pacijenti podvrgnuti SAVR-u dobne skupine ≥65 godina su imali znatno veći operacijski rizik (P=0,006), viši NYHA status (P=0,040) te nižu glomerularnu filtraciju (P=0,003) naspram dobne skupine <65 godina. Analizom parametara pacijenata podvrgnutih TAVI zahvatu ≤75 godina i SAVR zahvatu ≥65 godina je dokazana značajna razlika u danima hospitalizacije (P<0,001; medijan TAVI 3 dana, SAVR 13 dana). Pacijenti podvrgnuti SAVR-u i CABG-u u istom aktu imaju mnogo veći operativni rizik (P=0,003) te dužu hospitalizaciju (P<0,001).
ZAKLJUČCI: Trećina bolesnika bila je u dobi 65 do 75 godina. Nije bilo značajne razlike u izboru metode niti karakteristikama bolesnika te dobi što potvrđuje širenje primjene TAVI u mlađih i niskorizičnih bolesnika. Bolesnici liječeni TAVI metodom su imali vrlo brz oporavak i izvrsne hemodinamske parametre nakon zahvata. |
| Abstract (english) | OBJECTIVE: To present basic clinical characteristics and comorbidities of patients with severe aortic valve stenosis and to determine the differences between those treated with conventional open-heart surgery (SAVR) and transcatheter valve implantation (TAVI) during 2021 at University Hospital of Split.
PATIENTS AND METHODS: A total of 144 patients were included in this observational retrospective study, of whom 93 underwent TAVI procedure, and 51 SAVR. Age, gender, EuroSCORE II, NYHA stage, comorbidities, cardiac bypass, percutaneous coronary intervention, laboratory parameters, days of hospitalization and ultrasound parameters were analyzed. The data were entered into the Microsoft Excel program and statistically analyzed in R v3.2.2 program.
RESULTS: Out of a total of 144 patients hospitalized with a diagnosis of severe aortic stenosis, 93 (65%) underwent TAVI, and 51 (35%) underwent SAVR. In both groups, men predominated, in the TAVI group 56%, and in the SAVR group 69% of patients. Basic demographic, anamnestic, laboratory and ultrasound parameters in relation to the performed procedure show that TAVI patients are older, have weaker renal function and more comorbidities. A statistically significant difference was found in hospitalization days after the procedure (P<0.001; median TAVI 4 days, SAVR 19 days). Among TAVI patients, a higher number of previous cardiac surgical revascularizations (CABG) was found in the younger age group ≤75 years (P=0.033). Patients undergoing SAVR aged ≥65 years had a significantly higher operative risk (P=0.006), higher NYHA status (P=0.040) and lower glomerular filtration (P=0.003) compared to the age group <65 years. Analysis of the parameters of patients undergoing TAVI procedure ≤75 years and SAVR procedure ≥65 years showed a significant difference in hospitalization days (P<0.00; median TAVI 3 days, SAVR 13 days). Patients undergoing SAVR and CABG in the same act have a much higher operative risk (P=0.003) and a longer hospitalization (P<0.001).
CONCLUSIONS: A third of the patients were aged 65 to 75. There was no significant difference in the choice of the method or the characteristics of the patients and their age, which confirms the spread of the use of TAVI in younger and low-risk patients. Patients treated with the TAVI method had a very quick recovery and excellent hemodynamic parameters after the procedure. |
