Kotronias Rafail A, Scarsini Roberto, De Maria Giovanni L, Rajasundaram Skanda, Sayeed Rana, Krasopoulos George, Grebenik Catherine, Keiralla Amar, Newton James D, Banning Adrian P, Kharbanda Rajesh K
Oxford Heart Centre, Oxford University Hospitals, NHS Trust, Oxford, UK.
Department of Cardiovascular Medicine, University of Oxford, Oxford, UK.
Catheter Cardiovasc Interv. 2020 Aug;96(2):432-439. doi: 10.1002/ccd.28578. Epub 2019 Nov 19.
To identify clinical and procedural practice predictors of avoidable complications during transcatheter aortic valve replacement (TAVR).
TAVR is evolving as a viable strategy for treatment of aortic stenosis (AS). Vascular complications, major bleeding, or pericardial tamponade may be influenced by procedural practice.
The Oxford TAVR (OxTAVI) prospective registry was retrospectively analyzed to identify predictors of avoidable procedural complications in a contemporary cohort of transfemoral TAVR between January 2015 and September 2018. The primary endpoint was defined as a hierarchic composite of in-hospital mortality, pericardial effusion/cardiac tamponade, major bleeding, and vascular access complications. Individual components of the primary endpoint have been analyzed separately.
Five-hundred-twenty-nine patients underwent transfemoral TAVR using contemporary techniques during the study period and were enrolled in the OxTAVI registry. Female sex and high frailty were associated with a higher risk of death, major bleeding, vascular complication or pericardial tamponade. The use of ultrasound (US) guidance for vascular access management was independently associated with a reduced composite primary endpoint (OR = 0.35, CI:0.14-0.86, p = .02) after adjustment for clinical confounders, largely driven by a threefold reduction in vascular access complication (OR = 0.29, CI:0.15-0.55, p < .001). Performing rapid pacing via the left ventricle guidewire (LV-GW) was associated with a significant decrease in the risk of cardiac tamponade/pericardial effusion (OR = 0.19, CI:0.05-0.66, p = .009).
US-guided vascular access management and rapid pacing via the LV-GW are important determinants of reduced procedural complications during TAVR.
确定经导管主动脉瓣置换术（TAVR）期间可避免并发症的临床和操作实践预测因素。
TAVR正在发展成为治疗主动脉瓣狭窄（AS）的一种可行策略。血管并发症、大出血或心包填塞可能受操作实践影响。
对牛津TAVR（OxTAVI）前瞻性注册研究进行回顾性分析，以确定2015年1月至2018年9月期间当代经股动脉TAVR队列中可避免操作并发症的预测因素。主要终点定义为住院死亡率、心包积液/心脏填塞、大出血和血管通路并发症的分层综合指标。主要终点的各个组成部分已分别进行分析。
在研究期间，529例患者采用当代技术接受了经股动脉TAVR，并被纳入OxTAVI注册研究。女性和高虚弱度与死亡、大出血、血管并发症或心包填塞的较高风险相关。在调整临床混杂因素后，使用超声（US）引导进行血管通路管理与综合主要终点降低独立相关（OR = 0.35，CI：0.14 - 0.86，p = 0.02），这主要由血管通路并发症减少三倍驱动（OR = 0.29，CI：0.15 - 0.55，p < 0.001）。通过左心室导丝（LV - GW）进行快速起搏与心脏填塞/心包积液风险显著降低相关（OR = 0.19，CI：0.05 - 0.66，p = 0.009）。
US引导的血管通路管理和通过LV - GW进行快速起搏是TAVR期间操作并发症减少的重要决定因素。
