Hernández-Enriquez Marco, Andrea Rut, Brugaletta Salvatore, Jiménez-Quevedo Pilar, Hernández-García José María, Trillo Ramiro, Larman Mariano, Fernández-Avilés Francisco, Vázquez-González Nicolás, Iñiguez Andrés, Zueco Javier, Ruiz-Salmerón Rafael, Del Valle Raquel, Molina Eduardo, García Del Blanco Bruno, Berenguer Alberto, Valdés Mariano, Moreno Raúl, Urbano-Carrillo Cristóbal, Hernández-Antolín Rosana, Gimeno Federico, Cequier Ángel, Cruz Ignacio, López-Mínguez José Ramón, Aramendi José Ignacio, Sánchez Ángel, Goicolea Javier, Albarrán Agustín, Díaz José Francisco, Navarro Felipe, Moreu José, Morist Andrés, Fernández-Nofrerías Eduard, Fernández-Vázquez Felipe, Ten Francisco, Mainar Vicente, Mari Belén, Saenz Alberto, Alfonso Fernando, Diarte José Antonio, Sancho Manuel, Lezáun Román, Arzamendi Dabit, Sabaté Manel
Cardiology Department, Hospital Clinic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
Cardiology Department, Hospital Clínico San Carlos, Madrid, Spain.
Am J Cardiol. 2016 Aug 15;118(4):578-84. doi: 10.1016/j.amjcard.2016.05.054. Epub 2016 May 29.
Vascular complications in transcatheter aortic valve implantation using transfemoral approach are related to higher mortality. Complete percutaneous approach is currently the preferred technique for vascular access. However, some centers still perform surgical cutdown. Our purpose was to determine complications related to vascular access technique in the population of the Spanish TAVI National Registry. From January 2010 to July 2015, 3,046 patients were included in this Registry. Of them, 2,465 underwent transfemoral approach and were treated with either surgical cutdown and closure (cutdown group, n = 632) or percutaneous approach (puncture group, n = 1,833). Valve Academic Research Consortium-2 definitions were used to assess vascular and bleeding complications. Propensity matching resulted in 615 matched pairs. Overall, 30-day vascular complications were significantly higher in the puncture group (109 [18%] vs 42 [6.9%]; relative risk [RR] 2.60; 95% confidence interval [CI] 1.85 to 3.64, p <0.001) due mostly by minor vascular events (89 [15%] vs 25 [4.1%], RR 3.56, 95% CI 2.32 to 5.47, p <0.001). Bleeding rates were lower in the puncture group (18 [3%] vs 40 [6.6%], RR 0.45, 95% CI 0.26 to 0.78, p = 0.003) mainly driven by major bleeding (9 [1.5%] vs 21 [3.4%], RR 0.43, 95% CI 0.20 to 0.93, p = 0.03). At a mean follow-up of 323 days, complication rates remained significantly different between groups (minor vascular complications 90 [15%] vs 31 [5.1%], hazard ratio 2.99, 95% CI 1.99 to 4.50, p <0.001 and major bleeding 10 [1.6%] vs 21 [3.4%], hazard ratio 0.47, 95% CI 0.22 to 1.0, p = 0.04, puncture versus cutdown group, respectively). In conclusion, percutaneous approach yielded higher rates of minor vascular complications but lower rates of major bleeding compared with the surgical cutdown, both at 30-day and at mid-term follow-up in our population.
经股动脉途径进行经导管主动脉瓣植入术的血管并发症与较高的死亡率相关。完全经皮途径是目前血管穿刺的首选技术。然而，一些中心仍采用外科切开法。我们的目的是确定西班牙经导管主动脉瓣植入术国家注册中心人群中与血管穿刺技术相关的并发症。2010年1月至2015年7月，该注册中心纳入了3046例患者。其中，2465例采用经股动脉途径，分别接受外科切开及缝合术（切开组，n = 632）或经皮途径（穿刺组，n = 1833）。采用瓣膜学术研究联盟-2的定义来评估血管和出血并发症。倾向评分匹配后得到615对匹配病例。总体而言，穿刺组30天血管并发症显著更高（109例[18%] vs 42例[6.9%]；相对风险[RR] 2.60；95%置信区间[CI] 1.85至3.64，p <0.001），主要是轻微血管事件所致（89例[15%] vs 25例[4.1%]，RR 3.56，95% CI 2.32至5.47，p <0.001）。穿刺组出血率较低（18例[3%] vs 40例[6.6%]，RR 0.45，95% CI 0.26至0.78，p = 0.003），主要是大出血导致（9例[1.5%] vs 21例[3.4%]，RR 0.43，95% CI 0.20至0.93，p = 0.03）。平均随访323天，两组并发症发生率仍有显著差异（轻微血管并发症90例[15%] vs 31例[5.1%]，风险比2.99，95% CI 1.99至4.50，p <0.001；大出血10例[1.6%] vs 21例[3.4%]，风险比0.47，95% CI 0.22至1.0，p = 0.04，分别为穿刺组与切开组）。总之，在我们的研究人群中，无论是30天还是中期随访，经皮途径导致的轻微血管并发症发生率较高，但大出血发生率较低，与外科切开法相比。
