Faroux Laurent, Villecourt Aurélien, Guimaraes Leonardo, Wintzer-Wehekind Jérôme, Junquera Lucia, Arsenault Jean, Blanpain Thierry, Tassan-Mangina Sophie, Heroguelle Virginie, Ruggieri Vito Giovanni, Metz Damien, Kalavrouziotis Dimitri, Dumont Eric, Paradis Jean-Michel, Delarochellière Robert, Del Val David, Muntané-Carol Guillem, Mohammadi Siamak, Rodés-Cabau Josep
Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada; Department of Cardiology, Reims University Hospital, Reims, France; EA3797 VieFra, University of Reims Champagne-Ardenne, Reims, France.
Department of Cardiology, Reims University Hospital, Reims, France.
Ann Thorac Surg. 2021 May;111(5):1601-1606. doi: 10.1016/j.athoracsur.2020.06.114. Epub 2020 Sep 17.
The impact of novel alternative access and valve type on radiation exposure during transcatheter aortic valve replacement (TAVR) has not yet been evaluated. This study sought to determine the impact of a transarterial approach and prosthesis type on physician and patient exposure to radiation during TAVR.
This was a prospective study including 140 consecutive patients undergoing TAVR by transfemoral (n = 102) or transcarotid (TC) (n = 38) access at 2 centers. Implanted valves were the self-expanding Evolut R/PRO system (Medtronic, Minneapolis, MN; n = 38) and the balloon-expandable SAPIEN 3 valve (Edwards Lifesciences, Irvine, CA; n = 102). The primary endpoint was first operator radiation exposure. The secondary endpoint was patient radiation exposure.
First operator radiation exposure was 4-fold greater during TC TAVR (P < .001). The use of a self-expanding valve was associated with a longer x-ray time (P = .015) and a 2-fold greater first operator radiation dose (P = .018). Patient radiation dose was not significantly affected by arterial approach (P = .055) or valve type (P = .095). After adjustment for potential confounders, the TC approach remained associated with a 174.8% (95% confidence interval, 80.6-318.3, P < .001) increase in first operator radiation dose, whereas the use of a self-expanding valve no longer influenced the first operator dose (P = .630).
TC access and the use of a self-expanding valve were associated with a 4- and 2-fold greater first operator radiation exposure during TAVR procedures, respectively. Unlike the arterial approach, the effect of bioprosthesis type on radiation exposure was mainly related to x-ray time and was no longer significant after adjustment.
新型替代入路和瓣膜类型对经导管主动脉瓣置换术（TAVR）期间辐射暴露的影响尚未得到评估。本研究旨在确定经动脉入路和假体类型对TAVR期间术者和患者辐射暴露的影响。
这是一项前瞻性研究，纳入了在2个中心连续接受经股动脉（n = 102）或经颈动脉（TC）（n = 38）入路TAVR的140例患者。植入的瓣膜为自膨胀式Evolut R/PRO系统（美敦力公司，明尼阿波利斯，明尼苏达州；n = 38）和球囊扩张式SAPIEN 3瓣膜（爱德华生命科学公司，尔湾，加利福尼亚州；n = 102）。主要终点是主刀医生的辐射暴露。次要终点是患者的辐射暴露。
TC-TAVR期间主刀医生的辐射暴露高4倍（P <.001）。使用自膨胀瓣膜与更长的X线照射时间相关（P =.015），主刀医生的辐射剂量高2倍（P =.018）。患者辐射剂量未受到动脉入路（P =.055）或瓣膜类型（P =.095）的显著影响。在对潜在混杂因素进行调整后，TC入路仍与主刀医生辐射剂量增加174.8%（95%置信区间，80.6 - 318.3，P <.001）相关，而使用自膨胀瓣膜不再影响主刀医生的剂量（P =.630）。
在TAVR手术期间，TC入路和使用自膨胀瓣膜分别使主刀医生的辐射暴露高4倍和2倍。与动脉入路不同，生物假体类型对辐射暴露的影响主要与X线照射时间有关，调整后不再显著。
