Laakso Teemu, Moriyama Noriaki, Raivio Peter, Dahlbacka Sebastian, Kinnunen Eeva-Maija, Juvonen Tatu, Valtola Antti, Husso Annastiina, Jalava Maina P, Ahvenvaara Tuomas, Tauriainen Tuomas, Piuhola Jarkko, Lahtinen Asta, Niemelä Matti, Mäkikallio Timo, Virtanen Marko, Maaranen Pasi, Eskola Markku, Savontaus Mikko, Airaksinen Juhani, Biancari Fausto, Laine Mika
Heart and Lung Center, Helsinki University Hospital Helsinki Finland.
Heart Center, Kuopio University Hospital Kuopio Finland.
Circ Rep. 2020 Feb 28;2(3):182-191. doi: 10.1253/circrep.CR-20-0007.
The aim of this study was to investigate the impact of anatomical site status and major vascular complication (MVC) severity on the outcome of transfemoral transcatheter aortic valve replacement (TF-TAVR). The FinnValve registry enrolled consecutive TAVR patients from 2008 to 2017. MVC was divided into 2 groups: non-access site-related MVC (i.e., MVC in aorta, aortic valve annulus or left ventricle); and access site-related MVC (i.e., MVC in iliac or femoral arteries). Severity of access site-related MVC was measured as units of red blood cell (RBC) transfusion. Of 1,842 patients who underwent TF-TAVR, 174 had MVC (9.4%; non-access site related, n=29; access site related, n=145). Patients with MVC had a significantly higher 3-year mortality than those without MVC (40.8% vs. 24.3%; HR, 2.01; 95% CI: 1.16-3.62). Adjusted 3-year mortality risk was significantly increased in the non-access site-related MVC group (mortality, 77.8%; HR, 4.30; 95% CI: 2.63-7.02), but not in the access site-related MVC group (mortality, 32.6%; HR, 1.38; 95% CI: 0.86-2.15). In the access site-related MVC group, only those with RBC transfusion ≥4 units had a significantly increased 3-year mortality risk (mortality, 51.8%; HR, 2.18; 95% CI: 1.19-3.89). In patients undergoing TF-TAVR, MVC was associated with an increased 3-year mortality risk, incrementally correlating with anatomical site and bleeding severity.
本研究的目的是调查解剖部位状态和主要血管并发症（MVC）严重程度对经股动脉经导管主动脉瓣置换术（TF-TAVR）结局的影响。芬兰瓣膜注册研究纳入了2008年至2017年连续的TAVR患者。MVC分为两组：非穿刺部位相关的MVC（即主动脉、主动脉瓣环或左心室内的MVC）；以及穿刺部位相关的MVC（即髂动脉或股动脉内的MVC）。穿刺部位相关MVC的严重程度以红细胞（RBC）输注单位来衡量。在1842例行TF-TAVR的患者中，174例发生了MVC（9.4%；非穿刺部位相关的29例，穿刺部位相关的145例）。发生MVC的患者3年死亡率显著高于未发生MVC的患者（40.8%对24.3%；HR，2.01；95%CI：1.16-3.62）。非穿刺部位相关MVC组的校正3年死亡风险显著增加（死亡率77.8%；HR，4.30；95%CI：2.63-7.02），但穿刺部位相关MVC组未增加（死亡率32.6%；HR，1.38；95%CI：0.86-2.15）。在穿刺部位相关MVC组中，只有那些RBC输注≥4单位患者的3年死亡风险显著增加（死亡率51.8%；HR，2.18；95%CI：1.19-3.89）。在接受TF-TAVR的患者中，MVC与3年死亡风险增加相关，且与解剖部位和出血严重程度呈递增相关。
