Veulemans Verena, Wilde Nihal, Wienemann Hendrik, Adrichem Rik, Hokken Thijmen W, Al-Kassou Baravan, Shamekhi Jasmin, Mauri Victor, Maier Oliver, Jung Christian, Horn Patrick, Adam Matti, Nickenig Georg, Baldus Stephan, Van Mieghem Nicolas M, Kelm Malte, Sedaghat Alexander, Zeus Tobias
Department of Cardiology, Pulmonology, and Vascular Diseases, University Hospital Düsseldorf, Düsseldorf, Germany.
Cardiovascular Research Institute, Düsseldorf, Germany.
Front Cardiovasc Med. 2023 Jan 5;9:1064916. doi: 10.3389/fcvm.2022.1064916. eCollection 2022.
The deployment process of the largest self-expandable device (STHV-34) during transcatheter aortic valve implantation (TAVI) might be challenging due to stabilization issues. Whether the use of different TAVI-guidewires impact the procedural success and outcome is not well-known. Therefore, we sought to evaluate the impact of non-Lunderquist (NLu) vs. the Lunderquist (Lu) guidewires during TAVI using the STHV-34 on the procedural and 30-day outcomes.
The primary study endpoint was defined as the final implantation depth (ID) depending on the selected guidewire strategy. Key secondary endpoints included VARC-3-defined complications.
The study cohort included 398 patients of four tertiary care institutions, of whom 79.6% (317/398) had undergone TAVI using NLu and 20.4% (81/398) using Lu guidewires. Baseline characteristics did not substantially differ between NLu and Lu patients. The average ID was higher in the Lu cohort (NLu vs. Lu: -5.2 [-7.0-(-3.5)] vs. -4.5 [-6.0-(-3.0)]; = 0.022). The optimal ID was reached in 45.0% of patients according to former and only in 20.1% according to nowadays best practice recommendations. There was no impact of the guidewire use on the 30-day outcomes, including conduction disturbances and pacemaker need (NLu vs. Lu: 15.1 vs. 18.5%; = 0.706).
The use of the Lunderquist guidewire was associated with a higher ID during TAVI with the STHV-34 without measurable benefits in the 30-day course concerning conduction disturbances and associated pacemaker need. Whether using different guidewires might impact the outcome in challenging anatomies should be further investigated in randomized studies under standardized conditions.
在经导管主动脉瓣植入术（TAVI）期间，最大的自膨胀装置（STHV - 34）的部署过程可能因稳定问题而具有挑战性。不同的TAVI导丝的使用是否会影响手术成功率和结果尚不清楚。因此，我们试图评估在使用STHV - 34进行TAVI时，非伦德奎斯特（NLu）导丝与伦德奎斯特（Lu）导丝对手术过程和30天结果的影响。
主要研究终点定义为取决于所选导丝策略的最终植入深度（ID）。关键次要终点包括VARC - 3定义的并发症。
该研究队列包括来自四个三级医疗机构的398名患者，其中79.6%（317/398）使用NLu进行了TAVI，20.4%（81/398）使用Lu导丝。NLu和Lu患者的基线特征没有实质性差异。Lu队列中的平均ID更高（NLu与Lu：-5.2 [-7.0 - (-3.5)] 对 -4.5 [-6.0 - (-3.0)]；P = 0.022）。根据以前的标准，45.0%的患者达到了最佳ID，而根据目前最佳实践建议，只有20.1%的患者达到。导丝的使用对30天结果没有影响，包括传导障碍和起搏器需求（NLu与Lu：15.1%对18.5%；P = 0.706）。
在使用STHV - 34进行TAVI期间，使用伦德奎斯特导丝与更高的ID相关，但在30天病程中关于传导障碍和相关起搏器需求没有可测量的益处。在标准化条件下的随机研究中应进一步研究使用不同导丝是否可能影响具有挑战性解剖结构的结果。
