Department of Cardiology, St. Paul's Hospital, University of British Columbia, Vancouver, Canada.
J Am Coll Cardiol. 2012 Jan 10;59(2):113-8. doi: 10.1016/j.jacc.2011.08.069.
The aim of this study was to evaluate vascular complications in a consecutive patient population undergoing transfemoral percutaneous aortic valve replacement (PAVR) applying current Valve Academic Research Consortium definitions.
Vascular complications have been the major cause of mortality and morbidity associated with PAVR. Both open surgical and fully percutaneous access site strategies have been advocated.
All patients undergoing transfemoral PAVR during fiscal years 2009 and 2010 were prospectively evaluated at baseline, after the procedure, and at 30 days.
PAVR was performed in 137 consecutive patients. All but 1 patient underwent planned arteriotomy closure using a percutaneous pre-closure technique. Smaller sheaths, rigorous angiographic and computed tomographic screening and patient selection, and percutaneous vascular repair techniques were increasingly used over this period. From 2009 to 2010, major vascular complications decreased from 8% to 1% (p = 0.06), minor vascular complications decreased from 24% to 8% (p < 0.01), major bleeds fell from 14% to 1% (p < 0.01), and unplanned surgery decreased from 28% to 2% (p < 0.01). A minimal artery diameter smaller than the external sheath diameter, moderate or severe calcification, and peripheral vascular disease were associated with higher vascular complication rates.
Vascular complications occur more often if the minimal artery diameter is smaller than the external sheath diameter, in the presence of moderate or severe calcification, and in patients with peripheral vascular disease. With careful patient selection, advanced interventional techniques, and a fully percutaneous procedure, marked reductions in vascular and bleeding complications can be achieved.
本研究旨在应用当前的瓣膜学术研究联盟（Valve Academic Research Consortium，VARC）定义，评估连续接受经股动脉入路经皮主动脉瓣置换术（Percutaneous Aortic Valve Replacement，PAVR）的患者人群中的血管并发症。
血管并发症一直是与 PAVR 相关的死亡率和发病率的主要原因。已经提倡使用开放手术和完全经皮入路策略。
在 2009 年和 2010 年的财政年度中，对所有接受经股动脉 PAVR 的患者进行了前瞻性评估，包括基线时、手术后和 30 天时。
连续对 137 例患者进行了 PAVR。除 1 例患者外，所有患者均采用经皮预闭合技术进行计划的动脉切开术闭合。在此期间，逐渐使用了更小的鞘管、严格的血管造影和计算机断层扫描筛选以及患者选择和经皮血管修复技术。2009 年至 2010 年，主要血管并发症从 8%降至 1%（p = 0.06），次要血管并发症从 24%降至 8%（p < 0.01），主要出血从 14%降至 1%（p < 0.01），且计划外手术从 28%降至 2%（p < 0.01）。最小动脉直径小于外鞘直径、中度或重度钙化以及外周血管疾病与更高的血管并发症发生率相关。
如果最小动脉直径小于外鞘直径、存在中度或重度钙化以及患有外周血管疾病，则更常发生血管并发症。通过仔细的患者选择、先进的介入技术和完全经皮手术，可以显著降低血管和出血并发症的发生率。
