Cafaro Alessandro, Spione Francesco, Burattini Osvaldo, De Feo Daniele, Xhelo Alessandro, Palmitessa Chiara, D'Alessandro Maurizio, Amendola Vincenzo Pio, Rimmaudo Flavio, Guaricci Andrea Igoren, Bortone Alessandro Santo, Pestrichella Vincenzo, Contegiacomo Gaetano, Tesorio Tullio, Colonna Giuseppe, Iacovelli Fortunato
Division of Cardiology, "V. Fazzi" Hospital, 73100 Lecce, Italy.
Interventional Cardiology Service, "Montevergine" Clinic, GVM Care & Research, 83013 Mercogliano, Italy.
J Cardiovasc Dev Dis. 2023 Nov 13;10(11):459. doi: 10.3390/jcdd10110459.
Transcatheter aortic valve replacement (TAVR) is an almost totally cine-fluoroscopic guided procedure. The amount of radiation used during the procedure is strictly related to the fluoroscopy time (FT), that has already been demonstrated to be associated with outcomes and complexity of coronary procedures. The aim of our study is to demonstrate the relationship between FT and the short-term outcomes after TAVR defined by to the Valve Academic Research Consortium (VARC)-2 and -3 consensus documents.
After splitting 1797 consecutive patients into tertiles of FT, the composite endpoint early safety (ES) was adjudicated according to VARC-2 and VARC-3 definitions, whereas the composite endpoints device success (DS) and technical success (TS) according to VARC-3 criteria.
The absence of all these outcomes (VARC-2 ES amd VARC-3 TS, DS, and ES) was significantly associated with longer FT: this association was independent from both intraprocedural complications and other intraprocedural factors linked to longer FT, and still persisted after propensity score matching analysis. Notwithstanding, after receiver operating characteristic analysis, FT had adequate diagnostic accuracy in identifying the absence of only VARC-3 TS and VARC-2 ES.
Longer FT is related with periprocedural and short-term outcomes after the procedure, especially in those that are more challenging. A FT duration of more than 30 min has an adequate accuracy in identifying VARC-3 technical failure (TS and DS) and absence of VARC-2 ES, selecting patients who are likely to take advantage from more careful in-hospital follow-up.
经导管主动脉瓣置换术（TAVR）几乎完全是在荧光透视引导下进行的手术。手术过程中使用的辐射量与透视时间（FT）密切相关，已有研究表明透视时间与冠状动脉手术的结果和复杂性相关。我们研究的目的是证明FT与经导管主动脉瓣置换术后由瓣膜学术研究联盟（VARC）-2和-3共识文件定义的短期结果之间的关系。
将1797例连续患者按FT三分位数分组后，根据VARC-2和VARC-3定义判定复合终点早期安全性（ES），而根据VARC-3标准判定复合终点器械成功（DS）和技术成功（TS）。
所有这些结果（VARC-2 ES以及VARC-3 TS、DS和ES）的缺失与更长的FT显著相关：这种关联独立于术中并发症以及与更长FT相关的其他术中因素，并且在倾向评分匹配分析后仍然存在。尽管如此，经过接受者操作特征分析，FT在识别仅VARC-3 TS和VARC-2 ES缺失方面具有足够的诊断准确性。
更长的FT与术后围手术期和短期结果相关，尤其是在那些更具挑战性的手术中。FT持续时间超过30分钟在识别VARC-3技术失败（TS和DS）以及VARC-2 ES缺失方面具有足够的准确性，可筛选出可能受益于更仔细的院内随访的患者。
