Thirumala Parthasarathy D, Muluk Sruthi, Udesh Reshmi, Mehta Amol, Schindler John, Mulukutla Suresh, Jeevanantham Vinodh, Wechsler Lawrence, Gleason Thomas
Department of Neurological Surgery and Neurology; Neurology, University of Pittsburgh, Pittsburgh, PA, USA.
Harvard College, Boston, MA, USA.
Ann Card Anaesth. 2017 Apr-Jun;20(2):145-151. doi: 10.4103/aca.ACA_13_17.
OBJECTIVE/BACKGROUND: To examine the role of carotid stenosis (CS) and other independent risk factors of perioperative stroke, following transcatheter aortic valve implantation (TAVI).
Using data from the National Inpatient Sample database for analysis, patients who underwent TAVI were identified using the International Classification of Diseases, Ninth Revision, Clinical Modification codes. Various preoperative and perioperative risk factors and their association with perioperative strokes were studied.
Data on 7566 patients who underwent a TAVI procedure from 2012 to 2013 were extracted. The average age of the patient population was 81.2 ± 0.32 years. The overall perioperative stroke rate in our patient cohort was 2.79%. Majority (94.6%) of the strokes were ischemic. Multivariate analysis showed the following independent risk factors for perioperative strokes after TAVI: female gender odds ratio (OR) = 2.25 (95% confidence interval [CI], 1.42-3.57), higher van Walraven score OR = 6.6 (95% CI = 3.71-11.73), bilateral CS OR = 4.46 (95% CI = 2.03-9.82), and TAVI with a cardiac procedure done under cardiopulmonary bypass OR = 2.84 (95% CI = 1.57-5.14).
Bilateral carotid disease is a significant risk factor for perioperative strokes following TAVI. Preoperative screening with carotid Doppler to identify high-risk patients appears to be warranted. In addition, patients of female gender were found to have an increased risk for carotid disease.
目的/背景：探讨经导管主动脉瓣植入术（TAVI）后颈动脉狭窄（CS）及围手术期卒中其他独立危险因素的作用。
利用国家住院样本数据库的数据进行分析，采用国际疾病分类第九版临床修订本代码识别接受TAVI的患者。研究了各种术前和围手术期危险因素及其与围手术期卒中的关联。
提取了2012年至2013年接受TAVI手术的7566例患者的数据。患者群体的平均年龄为81.2±0.32岁。我们患者队列中的总体围手术期卒中发生率为2.79%。大多数（94.6%）卒中为缺血性。多因素分析显示TAVI后围手术期卒中的以下独立危险因素：女性性别优势比（OR）=2.25（95%置信区间[CI]，1.42 - 3.57），较高的范瓦尔拉文评分OR = 6.6（95%CI = 3.71 - 11.73），双侧CS OR = 4.46（95%CI = 2.03 - 9.82），以及在体外循环下进行心脏手术的TAVI OR = 2.84（95%CI = 1.57 - 5.14）。
双侧颈动脉疾病是TAVI后围手术期卒中的重要危险因素。术前用颈动脉多普勒进行筛查以识别高危患者似乎是必要的。此外，发现女性患者患颈动脉疾病的风险增加。
