Lee Yung-Tsai, Yin Wei-Hsian, Yu Ho-Ping, Wei Jeng
Heart Center, Cheng-Hsin General Hospital.
Faculty of Medicine, School of Medicine, National Yang Ming University, Taipei, Taiwan.
Acta Cardiol Sin. 2018 Jan;34(1):37-48. doi: 10.6515/ACS.201801_34(1).20170911A.
Transfemoral (TF) access is associated with lower rates of surgical conversion and mortality compared with non-TF access for transcatheter aortic valve replacement (TAVR). Therefore, efforts should be made to make this procedure even less invasive, allowing more TAVR procedures to be performed through femoral access. We herein describe our single-center experience of using one-stage percutaneous internal endoconduits for TAVR in patients with unfavorable iliac artery anatomy.
Between March 2013 andMarch 2016, 113 consecutive patients with severe aortic stenosis at high risk for conventional cardiac surgery underwent TAVR at the Cheng Hsin General Hospital. The patients can be divided into Cohort A (March 2013-December 2014) and Cohort B (January 2015-March 2016).
In the Cohort A, 6 out of the 53 (11.4%) with unfavorable iliac artery anatomy were treated by trans-subclavian approach (n = 3, 5.7%) or direct aortic approach (n = 3, 5.7%); while in the Cohort B, none (0%) of the 5 patients with unfavorable iliac artery anatomy among 60 consecutive TAVR cases needed non-TF approach (Cohort A vs. Cohort B = 11.4% vs. 0%, p = 0.024) and they were all successfully treated with the use of an internal endoconduit.
The use of internal endoconduits can further increase the number of patients who can be treated through femoral artery access for TAVR and substantially reduce the need of non-TF approaches.
与经导管主动脉瓣置换术（TAVR）的非经股动脉入路相比，经股动脉（TF）入路与更低的手术转换率和死亡率相关。因此，应努力使该手术的侵入性更小，以使更多的TAVR手术能够通过股动脉入路进行。我们在此描述了我们在髂动脉解剖结构不佳的患者中使用单阶段经皮内置导管进行TAVR的单中心经验。
2013年3月至2016年3月，113例连续的严重主动脉瓣狭窄且传统心脏手术风险高的患者在成信总医院接受了TAVR。这些患者可分为A组（2013年3月至2014年12月）和B组（2015年1月至2016年3月）。
在A组中，53例髂动脉解剖结构不佳的患者中有6例（11.4%）采用经锁骨下动脉入路（n = 3，5.7%）或直接主动脉入路（n = 3，5.7%）进行治疗；而在B组中，60例连续TAVR病例中5例髂动脉解剖结构不佳的患者均无需非TF入路（A组与B组 = 11.4% 对 0%，p = 0.024），并且他们均通过使用内置导管成功治疗。
使用内置导管可进一步增加能够通过股动脉入路进行TAVR治疗的患者数量，并大幅减少对非TF入路的需求。
