Perrin Nils, Ellenberger Christoph, Licker Marc, Hachulla Anne-Lise, Cikirikcioglu Mustafa, Frei Angela, Roffi Marco, Noble Stéphane
Cardiology Division, University Hospital of Geneva, 4, rue Gabrielle-Perret-Gentil, 1211 Geneva 14, Switzerland.
Anaesthesiology Department, University Hospital of Geneva, Geneva, Switzerland.
Arch Cardiovasc Dis. 2015 Oct;108(10):491-501. doi: 10.1016/j.acvd.2015.03.007.
Vascular complications (VCs) after transcatheter aortic valve implantation (TAVI) are frequent and their management is challenging.
To report the incidence, predictors and management of VCs following percutaneous transfemoral TAVI (TF-TAVI) at a single centre.
We analyzed 102 consecutive patients who underwent percutaneous TF-TAVI between August 2008 and December 2013. All endpoints were evaluated at 30 days and 6 months according to Valve Academic Research Consortium-2 criteria. VC percutaneous treatment success was defined as residual stenosis<30%, absence of blood extravasation and absence of surgical or repeat endovascular intervention at 30 days.
Twenty-two patients (22%) experienced VCs, including five patients (5%) with major VCs. Mortality at 30 days was significantly higher in patients with major VCs than in patients without major VCs (60% vs 3%; P=0.001). Patients with VCs had more life-threatening or major bleeding (23% vs 5%; P=0.02), but no difference in terms of need for blood transfusion was observed. Endovascular treatment was used in 13 of 22 patients with VCs (59%) and was successful in 11 of these 13 patients (85%). Primary surgical repair was necessary in only 1/22 (5%) patients, for a common femoral artery pseudoaneurysm 2 weeks after the TAVI procedure.
VCs following TF-TAVI are frequent. Major but not minor VCs are associated with increased mortality. Percutaneous management of VCs is feasible and safe, and surgery is rarely needed.
经导管主动脉瓣植入术（TAVI）后血管并发症（VCs）很常见，其处理具有挑战性。
报告单中心经皮股动脉TAVI（TF-TAVI）后VCs的发生率、预测因素及处理情况。
我们分析了2008年8月至2013年12月期间连续接受经皮TF-TAVI的102例患者。所有终点均根据瓣膜学术研究联盟-2标准在30天和6个月时进行评估。VC经皮治疗成功定义为残余狭窄<30%、无血液外渗且30天时无需手术或再次血管内介入。
22例患者（22%）发生VCs，其中5例（5%）为严重VCs。严重VCs患者30天死亡率显著高于无严重VCs患者（60%对3%；P=0.001）。发生VCs的患者有更多危及生命或严重出血情况（23%对5%；P=0.02），但在输血需求方面未观察到差异。22例发生VCs的患者中有13例（59%）接受了血管内治疗，其中11例（85%）成功。仅1/22（5%）例患者在TAVI术后2周因股总动脉假性动脉瘤需要进行一期手术修复。
TF-TAVI后VCs很常见。严重而非轻微的VCs与死亡率增加相关。VCs的经皮处理可行且安全，很少需要手术。
