Institut Cardiovasculaire Paris Sud, Massy, France.
JACC Cardiovasc Interv. 2011 Aug;4(8):851-8. doi: 10.1016/j.jcin.2011.03.019.
This study sought to evaluate the incidence, impact, and predictors of vascular complications in transcatheter aortic valve implantation (TAVI).
Vascular complications increase morbidity and mortality in transfemoral TAVI; however, there remains a paucity of data describing these serious events.
We performed a prospective cohort study of 130 consecutive transfemoral TAVI recipients. Vascular complications were defined by the Valve Academic Research Consortium (VARC) criteria. The ratio of the sheath outer diameter (in millimeters) to the minimal femoral artery diameter (in millimeters) defined the sheath to femoral artery ratio (SFAR).
In our cohort of elderly patients (83.3 ± 5.9 years), the logistic EuroScore was 25.8% ± 11.9%. The Edwards valve was used in 102 cases (18- to 24-F) and the CoreValve in 27 (18-F). The minimal femoral artery diameter was 8.17 ± 1.14 mm, and the calcification (0 to 3) and tortuosity scores (0 to 3) were 0.58 ± 0.72 and 0.28 ± 0.53, respectively. The mean sheath diameter was 8.10 ± 0.82 mm, and the mean SFAR was 0.99 ± 0.16. Vascular complications occurred in 27.6% (VARC major: 17.3%, minor: 10.2%), and major vascular complications predicted 30-day mortality (22.7% vs. 7.6%, p = 0.049). The SFAR (hazard ratio [HR]: 186.20, 95% confidence interval [CI]: 4.41 to 7,855.11), center experience (HR: 3.66, 95% CI: 1.17 to 11.49), and femoral calcification (HR: 3.44, 95% CI: 1.16 to 10.17) predicted major complications by multivariate analysis. An SFAR threshold of 1.05 (area under the curve = 0.727) predicted a higher rate of VARC major complications (30.9% vs. 6.9%, p = 0.001) and 30-day mortality (18.2% vs. 4.2%, p = 0.016).
Vascular complications in transfemoral TAVI are relatively frequent. VARC major vascular complications increase 30-day mortality and are predicted by experience, femoral calcification, and SFAR. Routine application of SFAR will improve patient selection for transfemoral TAVI and may improve outcome.
本研究旨在评估经导管主动脉瓣植入术（TAVI）中血管并发症的发生率、影响和预测因素。
血管并发症会增加经股 TAVI 的发病率和死亡率；然而，目前仍缺乏描述这些严重事件的数据。
我们对 130 例连续经股 TAVI 接受者进行了前瞻性队列研究。血管并发症根据 Valve Academic Research Consortium（VARC）标准定义。鞘管外径（毫米）与股动脉最小直径（毫米）的比值定义为鞘管与股动脉比（SFAR）。
在我们的老年患者队列中（83.3±5.9 岁），逻辑 EuroScore 为 25.8%±11.9%。102 例使用 Edwards 瓣膜（18-24-F），27 例使用 CoreValve（18-F）。股动脉最小直径为 8.17±1.14mm，钙化（0 至 3）和迂曲评分（0 至 3）分别为 0.58±0.72 和 0.28±0.53。鞘管直径平均为 8.10±0.82mm，平均 SFAR 为 0.99±0.16。血管并发症发生率为 27.6%（VARC 主要：17.3%，次要：10.2%），主要血管并发症预测 30 天死亡率（22.7% vs. 7.6%，p=0.049）。SFAR（危险比[HR]：186.20，95%置信区间[CI]：4.41 至 7855.11）、中心经验（HR：3.66，95%CI：1.17 至 11.49）和股动脉钙化（HR：3.44，95%CI：1.16 至 10.17）经多变量分析预测主要并发症。SFAR 阈值为 1.05（曲线下面积=0.727）预测 VARC 主要血管并发症的发生率更高（30.9% vs. 6.9%，p=0.001）和 30 天死亡率（18.2% vs. 4.2%，p=0.016）。
经股 TAVI 中的血管并发症相对常见。VARC 主要血管并发症增加 30 天死亡率，并可通过经验、股动脉钙化和 SFAR 预测。SFAR 的常规应用将改善经股 TAVI 的患者选择，并可能改善预后。
