Coronary Cannulation After Transcatheter Aortic Valve Replacement The RE-ACCESS Study
Coronary Cannulation After Transcatheter Aortic Valve Replacement The RE-ACCESS Study
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DOI：
10.1016/j.jcin.2020.07.006
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发表时间：
2020-11-09
影响因子：
11.3
通讯作者：
Tamburino, Corrado
中科院分区：
文献类型：
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作者：
Barbanti, Marco;Costa, Giuliano;Tamburino, Corrado
本研究的目的是调查经导管主动脉瓣置换术（TAVR）后冠状动脉口插管的可行性，并评估冠状动脉通路损伤的潜在预测因素。背景缺乏有关TAVR后冠状动脉插管可行性和可重复性的某些数据。（在经导管主动脉瓣支架之外重新获得冠状动脉口插管）是一项由起搏器驱动的单中心前瞻性研究，基于注册的研究，入组了使用所有市售器械接受TAVR的连续患者。所有患者在TAVR前后均接受了冠状动脉造影。主要终点为TAVR术后冠状动脉口插管失败率。次要终点为TAVR术后无法选择性插管冠状动脉口相关因素的识别。结果2018年12月至2020年1月，RE-ACCESS研究入组的300例患者中，共有23例（7.7%）TAVR术后冠状动脉插管失败。使用Evolut R/PRO经导管主动脉瓣（TAV）的23例病例中有22例发生了该问题（17.9% vs. 0.4%; p < 0.01）。在多变量分析中，Evolut R/PRO TAV的使用（比值比[OR]：29.6; 95%置信区间[CI]：2.6 - 335.0; p < 0.01），主动脉瓣-主动脉窦关系（OR：1.1/1 mm增加; 95% CI：1.0 - 1.2; p < 0.01），平均TAV植入深度（OR：1.7/1 mm减小; 95% CI：1.3 - 2.3; p < 0.01）是TAVR术后冠状动脉插管不成功的独立预测因素。结合这些因素的模型被证明可以非常高的准确性预测TAVR后冠状动脉插管不成功的风险（曲线下面积：0.94; p < 0.01）。结论在7.7%的患者中观察到TAVR后冠状动脉插管不成功，并且几乎完全发生在接受Evolut TAV的患者中。Evolut TAV、较高的TAV-主动脉窦关系和植入深度的组合可高准确度预测TAVR术后冠状动脉插管失败的风险。（美国心脏病学会基金会在经导管主动脉瓣支架之外重新获得冠状动脉口插管[RE-ACCESS]; NCT 04026204）（C）2020。
OBJECTIVES The aims of this study were to investigate the feasibility of coronary ostia cannulation after transcatheter aortic valve replacement (TAVR) and to assess potential predictors of coronary access impairment.BACKGROUND Certain data concerning the feasibility and reproducibility of coronary cannulation after TAVR are lacking.METHODS RE-ACCESS (Reobtain Coronary Ostia Cannulation Beyond Transcatheter Aortic Valve Stent) was an investigator-driven, single-center, prospective, registry-based study that enrolled consecutive patients undergoing TAVR using all commercially available devices. All patients underwent coronary angiography before and after TAVR. The primary endpoint was the rate of unsuccessful coronary ostia cannulation after TAVR. Secondary endpoints were the identification of factors associated with the inability to selectively cannulate coronary ostia after TAVR.RESULTS Among 300 patients enrolled in the RE-ACCESS study from December 2018 to January 2020, a total of 23 cases (7.7%) of unsuccessful coronary cannulation after TAVR were documented. This issue occurred in 22 of 23 cases with the use of Evolut R/PRO transcatheter aortic valves (TAVs) (17.9% vs. 0.4%; p < 0.01). In multivariate analysis, the use of Evolut R/PRO TAVs (odds ratio [OR]: 29.6; 95% confidence interval [CI]: 2.6 to 335.0; p < 0.01), the TAV-sinus of Valsalva relation (OR: 1.1 per 1-mm increase; 95% CI: 1.0 to 1.2; p < 0.01), and the mean TAV implantation depth (OR: 1.7 per 1-mm decrease; 95% CI: 1.3 to 2.3; p < 0.01) were found to be independent predictors of unsuccessful coronary cannulation after TAVR. A model combining these factors was demonstrated to predict with very high accuracy the risk for unsuccessful coronary cannulation after TAVR (area under the curve: 0.94; p < 0.01).CONCLUSIONS Unsuccessful coronary cannulation following TAVR was observed in 7.7% of patients and occurred almost exclusively in those receiving Evolut TAVs. The combination of Evolut TAV, a higher TAV-sinus of Valsalva relation, and implantation depth predicts with high accuracy the risk for unsuccessful coronary cannulation after TAVR. (Reobtain Coronary Ostia Cannulation Beyond Transcatheter Aortic Valve Stent [RE-ACCESS]; NCT04026204) (C) 2020 by the American College of Cardiology Foundation.