Department of Molecular and Clinical Medicine, Gothenburg University, Sweden.
Department of Cardiology, Sahlgrenska University Hospital, Sweden.
Catheter Cardiovasc Interv. 2024 Sep;104(3):570-582. doi: 10.1002/ccd.31171. Epub 2024 Jul 31.
Transcatheter aortic valve replacement (TAVR) is the most common treatment in patients with symptomatic severe aortic stenosis (AS). As concomitant coronary artery disease is common in AS patients, access to the coronary arteries following TAVR is of increasing importance.
This study evaluated the incidence and risk factors for unplanned coronary angiography following TAVR and, using fluoroscopic time as a surrogate, analyzed the complexity of coronary artery cannulation.
All patients who underwent TAVR in Sweden between 2008 and 2022 were identified using the SWEDEHEART registry. The cumulative incidence of coronary angiography after TAVR was analyzed with mortality as a competing risk. Angiography and PCI complexity were analyzed using fluoroscopic time and compared across different transcatheter heart valve designs.
Out of 9806 patients, 566 subsequently required coronary angiography. The incidence was highest for three-vessel and/or left main disease. Younger age, the extent of prior coronary artery disease, and peripheral vascular disease were associated with an increased risk of coronary angiography. Fluoroscopy time was increased in TAVR patients compared to the control group with the longest fluoroscopy times observed in cases involving supra-annular and self-expanding valves.
The incidence of coronary angiography following TAVR is still low. Younger patients and patients with concomitant coronary artery disease have a higher risk. Procedural time is longer in patients with a previous THV replacement. As TAVR is emerging as the first-line treatment in patients with longer life expectancy, facilitating coronary access is an important factor when considering which THV device to implant.
经导管主动脉瓣置换术（TAVR）是有症状的重度主动脉瓣狭窄（AS）患者最常见的治疗方法。由于 AS 患者常合并冠状动脉疾病，因此 TAVR 后对冠状动脉的通路的处理变得越来越重要。
本研究评估了 TAVR 后计划外冠状动脉造影的发生率和危险因素，并使用透视时间作为替代指标，分析了冠状动脉插管的复杂性。
使用 SWEDEHEART 登记处，确定了 2008 年至 2022 年期间在瑞典接受 TAVR 的所有患者。使用死亡率作为竞争风险分析 TAVR 后冠状动脉造影的累积发生率。使用透视时间分析造影和 PCI 的复杂性，并比较不同经导管心脏瓣膜设计之间的差异。
在 9806 例患者中，有 566 例随后需要进行冠状动脉造影。三血管和/或左主干疾病的发生率最高。年龄较轻、既往冠状动脉疾病的严重程度和外周血管疾病与冠状动脉造影风险增加相关。与对照组相比，TAVR 患者的透视时间增加，其中涉及瓣环上和自膨式瓣膜的病例透视时间最长。
TAVR 后行冠状动脉造影的发生率仍然较低。年轻患者和合并冠状动脉疾病的患者风险更高。既往有 THV 置换的患者手术时间较长。随着 TAVR 作为预期寿命较长的患者的一线治疗方法，在考虑植入哪种 THV 装置时，便于获得冠状动脉通路是一个重要因素。
