Lareyre Fabien, Raffort Juliette, Dommerc Carine, Habib Yacoub, Bourlon François, Mialhe Claude
1 Cardiovascular Surgery Unit, Cardiothoracic Centre of Monaco, Monaco, France.
2 University of Côte d'Azur, INSERM, CNRS, IRCAN, Nice, France.
Angiology. 2018 Feb;69(2):143-150. doi: 10.1177/0003319717711589. Epub 2017 Jun 1.
Transcatheter aortic valve implantation (TAVI) is associated with substantial rates of vascular complications. The aim of our study is to describe the surgical management of percutaneous transfemoral access by a vascular surgeon and to report the 30-day postoperative vascular complications and mortality. Perioperative procedures to manage the femoral access site were recorded retrospectively from 220 consecutive patients who underwent TAVI. Postoperative vascular complications related to the main access were categorized according to the Valve Academic Research Consortium 2 classification. Perioperative procedures related to vascular access were performed for 56 (25.4%) patients: 6 patients required open surgical repair, 48 patients underwent endovascular stenting, and 2 patients had both procedures. The all-cause mortality was 3.6%, but no death related to a vascular complication was reported during the 30-day postoperative follow-up period. Ten (4.5%) patients developed postoperative hematomas; 2 (0.9%) of them were retroperitoneal and led to major bleeding requiring an unplanned surgical intervention. Our study underlines the utility of a multidisciplinary approach to manage the percutaneous access in TAVI for managing postoperative vascular complications.
经导管主动脉瓣植入术（TAVI）与较高的血管并发症发生率相关。我们研究的目的是描述血管外科医生对经皮股动脉入路的手术管理，并报告术后30天的血管并发症及死亡率。对连续220例行TAVI的患者经皮股动脉入路的围手术期操作进行回顾性记录。与主要入路相关的术后血管并发症根据瓣膜学术研究联盟2分类法进行分类。56例（25.4%）患者进行了与血管入路相关的围手术期操作：6例患者需要进行开放手术修复，48例患者接受了血管内支架置入术，2例患者两种操作都进行了。全因死亡率为3.6%，但在术后30天的随访期内未报告与血管并发症相关的死亡病例。10例（4.5%）患者出现术后血肿；其中2例（0.9%）为腹膜后血肿，导致大出血，需要进行非计划的手术干预。我们的研究强调了多学科方法在TAVI中管理经皮入路以处理术后血管并发症方面的实用性。
