Koren Ofir, Patel Vivek, Naami Robert, Naami Edmund, Nagasaka Takashi, Shechter Alon, Natanzon Sharon Shalom, Kohan Siamak, Allison Zev, Lerner Addee, Cheng Daniel Eugene, Chakravarty Tarun, Nakamura Mamoo, Cheng Wen, Jilaihawi Hasan, Makkar Raj R
Cedars-Sinai Medical Center, Smidt Heart Institute, Los Angeles, CA, United States.
Bruce Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel.
Front Cardiovasc Med. 2022 Sep 21;9:1004103. doi: 10.3389/fcvm.2022.1004103. eCollection 2022.
To assess the incidence of new adverse coronary events (NACE) following transcatheter aortic valve replacement (TAVR) and valve-in-valve TAVR (ViV-TAVR).
ViV-TAVR is an accepted treatment for degenerative prostheses among patients with high surgical-risk. TAVR studies have suggested an increased risk of coronary artery obstruction and flow stasis causing thrombus formation. Whether contemporary ViV-TAVR is associated with higher rate of coronary events compared to TAVR is unknown.
We used data from 1,224 TAVR patients between 2016 and 2021. We propensity-matched patients following ViV-TAVR and TAVR by significant predictors to overcome confounders in patients' baseline characteristics and procedural factors.
The matched population included 129 patients in each group. In line with prior reports, there was a higher in-hospital coronary artery obstruction rate with ViV-TAVR (3.1 vs. 1.6%; = 0.23). Despite this, 2-year cumulative NACE rates were similar between groups (4.7 vs. 6.2%, respectively, = 0.79), with no difference between its components: myocardial infarction (MI) ( = 0.210), unplanned coronary catheterization ( = 0.477), or coronary artery bypass grafting (CABG) ( = 0.998). Moreover, hypoattenuated leaflets thickening (HALT) at 30-day CT was observed in nearly a quarter of the patients with no difference between groups (23.9 vs. 23.1%, HR 1.02, 95% CI 0.50-1.28, = 0.872). The progression rate of the coronary artery calcium score (CACS), assessed in a third of patients, was similar between groups (p log-rank = 0.468, 95% CI 0.12-1.24). Low coronary artery height was an unfavorable predictor for in-hospital coronary obstruction and 2-year NACE rate (HR 1.20 and HR 1.25, = 0.001 and < 0.0001, respectively).
At 2-year follow-up, ViV-TAVR was not associated with a higher rate of myocardial infarction, unplanned catheterization, coronary artery bypass grafting, or hypoattenuated leaflet thickening.
评估经导管主动脉瓣置换术（TAVR）和瓣中瓣TAVR（ViV-TAVR）后新的不良冠状动脉事件（NACE）的发生率。
ViV-TAVR是高手术风险患者中退化性人工瓣膜的一种公认治疗方法。TAVR研究表明冠状动脉阻塞和血流淤滞导致血栓形成的风险增加。与TAVR相比，当代ViV-TAVR是否与更高的冠状动脉事件发生率相关尚不清楚。
我们使用了2016年至2021年间1224例TAVR患者的数据。我们通过显著预测因素对ViV-TAVR和TAVR后的患者进行倾向匹配，以克服患者基线特征和手术因素中的混杂因素。
匹配人群每组包括129例患者。与先前报告一致，ViV-TAVR的院内冠状动脉阻塞率更高（3.1%对1.6%；P = 0.23）。尽管如此，两组之间的2年累积NACE发生率相似（分别为4.7%和6.2%，P = 0.79），其组成部分之间无差异：心肌梗死（MI）（P = 0.210）、非计划冠状动脉导管插入术（P = 0.477）或冠状动脉旁路移植术（CABG）（P = 0.998）。此外，在近四分之一的患者中观察到30天CT时的低密度瓣叶增厚（HALT），两组之间无差异（23.9%对23.1%，HR 1.02，95%CI 0.50-1.28，P = 0.872）。在三分之一的患者中评估的冠状动脉钙化评分（CACS）进展率在两组之间相似（P对数秩 = 0.468，95%CI 0.12-1.24）。冠状动脉高度低是院内冠状动脉阻塞和2年NACE发生率的不利预测因素（HR 1.20和HR 1.25，P分别为0.001和<0.0001）。
在2年随访中，ViV-TAVR与更高的心肌梗死、非计划导管插入术、冠状动脉旁路移植术或低密度瓣叶增厚发生率无关。
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