Comparison of pulmonary complications in patients undergoing transcatheter aortic valve implantation versus open aortic valve replacement

摘要

Objective The purpose of this study was to investigate and compare the differences in postoperative pulmonary complications in patients undergoing aortic valve replacement by open repair (OAVR) versus those undergoing transcatheter aortic valve implantation by the transapical approach (TAVI-A) or transfemoral approach (TAVI-F). Design A retrospective review of data from aortic valve replacement patients. Setting A private, non-profit hospital. Participants Thirty patients with severe aortic stenosis requiring surgical replacement. Interventions Data collected from TAVI-F, TAVI-A, and OAVR patient charts. Materials and Methods Patients were divided into 3 groups: 10 patients undergoing OAVR, 10 patients undergoing TAVI-F, and 10 patients undergoing TAVI-A. Pulmonary complications and length of stay were recorded and analyzed. The TAVI-F group had the lowest number of total pulmonary complications per patient (1.0±0.667) compared to the OAVR group (1.8±0.789, p = 0.04) and TAVI-A group (2.0±1.054, p = 0.02). The most frequent complication was atelectasis. TAVI-F patients spent the least amount of time on the ventilator (TAVI-F median 2.6, IQR 4.8 h, TAVI-A median 4.9, IQR 7.6 h, and OAVR median 6.6, IQR 17.3 h, p = 0.02) and were discharged in half the time of the other groups (TAVI-F median 3.2, IQR 1.3 days, TAVI-A median 5.6, IQR 3.5 days, OAVR median 6.1, IQR 4.6 days, p = 0.008). Conclusions Due to the high incidence of multiple comorbidities and increased age, it is important to take into consideration the risk of pulmonary complications when choosing the surgical and anesthetic approach to TAVI in this high-risk group of patients.