Transcatheter aortic valve replacement in the setting of left atrial appendage thrombus.
Transcatheter aortic valve replacement in the setting of left atrial appendage thrombus.
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左心耳血栓情况下的经导管主动脉瓣置换术。
DOI：
10.1093/icvts/ivy189
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发表时间：
2018
影响因子：
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通讯作者：
Worku,BerhaneM
中科院分区：
文献类型：
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作者：
Salemi,Arash;DeMicheli,Andrea;Aftab,Abdullah;Elmously,Adham;Chang,Regis;Wong,SChiu;Worku,BerhaneM
左心耳血栓（LAT）是开创性经导管主动脉瓣置换术（TAVR）试验的排除标准;然而，此类患者确实在“真实世界”环境中接受了TAVR。本研究旨在分析LAT或自发性超声造影（SEC）患者TAVR后的结局。方法前瞻性分析2009年3月至2014年12月在我们机构接受TAVR的所有患者。通过回顾性病历审查确定是否存在LAT或SEC。主要结局包括30天和1年的神经系统事件以及死亡率。在接受TAVR的369例患者中，发现3.8%（14例）患有LAT，6.8%（25例）患有SEC，并将其分别与未患有LAT或SEC的患者进行比较。两组之间在术前肾功能、房颤和射血分数方面存在显著差异。术前房颤是LAT的唯一独立预测因素。没有围手术期并发症与LAT或SEC的存在相关。具体而言，没有LAT或SEC患者发生术后神经系统事件。虽然LAT和SEC均不是30天死亡率的独立预测因子，但LAT是1年死亡率的独立预测因子（比值比3.573，95%置信区间1.040 - 12.28; P = 0.042）。结论当前研究表明，TAVR可用于LAT和SEC患者，栓塞并发症风险较低。虽然这两项都不是30天死亡率的独立预测因素，但LAT是1年死亡率的独立预测因素。需要更大规模的研究来更好地研究这一现象。
OBJECTIVESLeft atrial appendage thrombus (LAT) was an exclusion criterion in the seminal transcatheter aortic valve replacement (TAVR) trials; however, such patients do undergo TAVR in the ‘real-world’ setting. This study sought to analyse outcomes after TAVR in patients with LAT or spontaneous echo contrast (SEC).METHODSAll patients undergoing TAVR at our institution between March 2009 and December 2014 were prospectively analysed. The presence of LAT or SEC was determined via a retrospective chart review. Primary outcomes included 30-day and 1-year neurological events as well as mortality.RESULTSOf the 369 patients undergoing TAVR, 3.8% (14) were found to have LAT and 6.8% (25) were found to have SEC, and they were separately compared to patients who did not have LAT or SEC. Significant differences were noted between groups with regard to preoperative renal function, atrial fibrillation and ejection fraction. Preoperative atrial fibrillation was the only independent predictor of LAT. No perioperative complications were associated with the presence of LAT or SEC. Specifically, no patient with LAT or SEC experienced a postoperative neurological event. While neither LAT nor SEC was an independent predictor of 30-day mortality, LAT was an independent predictor of 1-year mortality (odds ratio 3.573, 95% confidence interval 1.040–12.28;P= 0.042).CONCLUSIONSThe current study suggests that TAVR may be performed in patients with LAT and SEC with a low risk of embolic complications. While neither was an independent predictor of 30-day mortality, LAT was an independent predictor of 1-year mortality. Larger studies are needed to better study this phenomenon.