Patel Akshay, Mahendran Kajan, Collins Michael, Abdelaziz Mahmoud, Khogali Saib, Luckraz Heyman
Department of Cardiothoracic Surgery, Heart and Lung Centre, New Cross Hospital, Wolverhampton, UK.
Department of Radiology, Heart and Lung Centre, New Cross Hospital, Wolverhampton, UK.
Open Heart. 2018 Aug 27;5(2):e000855. doi: 10.1136/openhrt-2018-000855. eCollection 2018.
The aim of this retrospective series is to describe the prevalence and clinical significance of the incidental findings found during pre-transcatheter aortic valve implantation (TAVI) work-up and to ascertain the clinical course of such patients.
Consecutive patients undergoing TAVI from 2013 to 2015 where a TAVI CT assessment was performed (n=138) were included in the study. All incidental findings that were not expected from the patient's history were discussed at the TAVI multidisciplinary meeting in order to ascertain the clinical significance of said findings and whether they would alter the proposed course of treatment. Mortality data were determined by careful retrospective case note and follow-up appointment analysis.
Seventy-eight patients (57%) were found to have incidental findings on pre-TAVI CT scan. The majority of patients had benign pathology with high incidence in particular of diverticular disease, pleural effusions, gallstones, hiatus hernia and degenerative spinal disease. Vascular pathology such as superior mesenteric, renal and iliac artery stenoses and abdominal aortic aneurysm was detected in seven patients. In terms of long-term mortality data, we found no significant difference between those with incidental findings and those without (p=0.48). Survival as assessed by Kaplan-Meier analysis showed no significant difference between those with and without incidental abnormal CT scan findings (p=0.98).
Incidental findings with potential for malignancy are common in an elderly, comorbid population. Ultimately, clinical correlation and prognosis must be swiftly ascertained in order to streamline the patients down the appropriate management pathway while avoiding unnecessary delay for treatment of their aortic stenosis.
本回顾性系列研究旨在描述经导管主动脉瓣植入术（TAVI）术前检查中偶然发现的情况的发生率及其临床意义，并确定此类患者的临床病程。
纳入2013年至2015年接受TAVI且进行了TAVI CT评估的连续患者（n = 138）。所有根据患者病史未预期到的偶然发现均在TAVI多学科会议上进行讨论，以确定这些发现的临床意义以及它们是否会改变拟议的治疗方案。通过仔细回顾病例记录和随访预约分析来确定死亡率数据。
78例患者（57%）在TAVI术前CT扫描中发现有偶然发现。大多数患者有良性病变，其中憩室病、胸腔积液、胆结石、食管裂孔疝和退行性脊柱疾病的发生率尤其高。7例患者检测到血管病变，如肠系膜上动脉、肾动脉和髂动脉狭窄以及腹主动脉瘤。就长期死亡率数据而言，我们发现有偶然发现的患者与无偶然发现的患者之间无显著差异（p = 0.48）。通过Kaplan-Meier分析评估的生存率显示，有偶然CT扫描异常发现的患者与无异常发现的患者之间无显著差异（p = 0.98）。
在老年、合并多种疾病的人群中，有潜在恶性可能的偶然发现很常见。最终，必须迅速确定临床相关性和预后，以便将患者简化至适当的管理路径，同时避免主动脉瓣狭窄治疗的不必要延误。
