Incidence, Technical Safety, and Feasibility of Coronary Angiography and Intervention Following Self-expanding Transcatheter Aortic Valve Replacement
Incidence, Technical Safety, and Feasibility of Coronary Angiography and Intervention Following Self-expanding Transcatheter Aortic Valve Replacement
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DOI：
10.1016/j.carrev.2019.01.026
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发表时间：
2019-05-01
影响因子：
1.7
通讯作者：
Latib, Azeem
中科院分区：
文献类型：
--
作者：
Tanaka, Akihito;Jabbour, Richard J.;Latib, Azeem
背景：经导管主动脉瓣置换术（TAVR）是重度主动脉瓣狭窄（AS）的成熟治疗选择。AS和冠状动脉疾病经常同时发生，因此有些患者可能需要在TAVR后进行冠状动脉造影（CAG）和/或介入治疗（PCI）。由于瓣膜支架的设计，大多数自膨式假体始终覆盖冠状动脉口，因此可能会阻碍未来的入路。本研究的目的是评价既往自膨式TAVR瓣膜患者行CAG/PCI的发生率、安全性和可行性。在2170例患者中（年龄82 +/- 6岁，43%男性），作为意大利CoreValve ClinicalService（R）框架的一部分，使用Corevalve或Evolut假体进行TAVR（数据来自13家意大利中心），TAVR术后CAG/PCI的发生率和围手术期特征进行了检查。（1.9%）需要CAG和/或PCI（共46例; CAG 16例，PCI 14例，PCI/CAG 16例）。56.5%的手术是在紧急情况下进行的。左冠状动脉造影成功率为87.5%（28/32），右冠状动脉造影成功率为50.0%（16/32）。93.3%（28/30）的手术成功进行PCI（左系统20例，右系统3例，移植物4例）。无CAG/PCI手术相关并发症，包括假体脱位或冠状动脉口夹层occurrence.Conclusions：CAG和PCI手术后CoreValve TAVR是安全的，大部分是可行的，虽然选择性右冠状动脉造影的成功率相对较低时，与左系统。需要进一步调查以探讨这一问题。(c)2019由Elsevier Inc.出版
Background: Transcatheter aortic valve replacement (TAVR) is a well-established treatment option for severe aortic stenosis (AS). AS and coronary artery disease frequently coincide, and therefore some patients may require coronary angiography (CAG) and/or intervention (PCI) post-TAVR. Due to valve stent design, most self-expanding prostheses always cover the coronary ostium, and therefore may hinder future access. The objective of this research was to evaluate the incidence, safety and feasibility of CAG/PCI in patients with prior self-expanding TAVR valves.Methods: Among 2170 patients (age 82 +/- 6 years, 43% male) who underwent TAVR with Corevalve or Evolut prostheses, as part of the Italian CoreValve ClinicalService (R) framework (data from 13 Italian centers), the occurrence of CAG/PCI following TAVR and periprocedural characteristics were examined.Results: During median follow-up of 379 days, 41 patients (1.9%) required CAG and/or PCI (total 46; 16 CAG, 14 PCI, 16 both PCI/CAG). 56.5% of the procedures were performed under emergency/urgency settings. Left system coronary angiography was successfully performed in most cases (28/32, 87.5%), while right coronary angiography was successful only in 50.0% (16/32). PCI procedures (20 for left system, 3 for right system, 4 for graft) were successfully performed in 93.3% (28/30) of the procedures. No CAG/PCI procedure-related complications including prosthesis dislodgment or coronary ostium dissection occurred.Conclusions: CAG and PCI procedures following CoreValve TAVR is safe and mostly feasible, although the success rate of selective right coronary angiography was relatively low when compared to the left system. Further investigations are required to explore this issue. (c) 2019 Published by Elsevier Inc.