Showkathali Refai, Sen Arup, Brickham Beth, Dworakowski Rafal, Wendler Olaf, MacCarthy Philip
Department of Cardiology, King's College Hospital, Denmark Hill, London, United Kingdom.
EuroIntervention. 2015 Aug;11(4):465-9. doi: 10.4244/EIJY14M06_04.
To characterise the clinical course of patients who had incidental findings on the CT aortogram (CTA) done as a transcatheter aortic valve implantation (TAVI) work-up investigation.
All patients who underwent CTA as a work-up investigation for TAVI were retrospectively recruited (n=295, 83±6.7 years) to identify those with an incidental finding. A total of 323 incidental findings were identified in 201 (68.1%) patients. Of those with incidental findings, 87 (43.3%) had at least one of immediate clinical significance. Within this group, fewer (52.9%) eventually had TAVI compared to those without incidental findings (63%). In patients going on to have TAVI, the time between CTA and TAVI was longer in those with incidental findings (median 96 vs. 81 days). At follow-up, overall mortality in those with incidental findings was higher than in those without (49.4% vs. 37.5%). In patients who underwent TAVI, there was a trend to increased mortality in those with incidental findings (34.8% vs. 21.4%, p=0.07).
Incidental findings were associated with a longer time to TAVI procedure, lower chance of eventually receiving TAVI as definitive therapy and a worse overall outcome. Such findings are clearly important and should be taken into account when delivering a contemporary TAVI service.
描述在经导管主动脉瓣植入术（TAVI）术前检查的CT主动脉造影（CTA）中发现意外情况的患者的临床病程。
回顾性纳入所有接受CTA作为TAVI术前检查的患者（n = 295，83±6.7岁），以确定那些有意外发现的患者。在201名（68.1%）患者中总共发现了323项意外发现。在有意外发现的患者中，87名（43.3%）至少有一项具有即刻临床意义。在这一组中，最终接受TAVI的患者比例（52.9%）低于无意外发现的患者（63%）。在继续接受TAVI的患者中，有意外发现的患者从CTA到TAVI的时间更长（中位数96天对81天）。在随访时，有意外发现的患者的总体死亡率高于无意外发现的患者（49.4%对37.5%）。在接受TAVI的患者中，有意外发现的患者有死亡率增加的趋势（34.8%对21.4%，p = 0.07）。
意外发现与更长的TAVI手术时间、最终接受TAVI作为确定性治疗的机会降低以及更差的总体结局相关。这些发现显然很重要，在提供现代TAVI服务时应予以考虑。
