Department of Cardiology, Alfred Health, Melbourne, Victoria, Australia.
Department of Cardiology, Cabrini Hospital, Melbourne, Victoria, Australia.
Catheter Cardiovasc Interv. 2024 Oct;104(4):812-819. doi: 10.1002/ccd.31185. Epub 2024 Aug 13.
Vascular complications post-transcatheter aortic valve implantation (TAVI) are common. Recent data regarding predictors of vascular complications are limited, particularly comparing newer plug-based devices versus traditional suture-based vascular closure devices (VCD).
The primary objective was to identify characteristics that predict a higher risk of vascular complications in TAVI patients, as judged by the VARC-3 criteria, specifically comparing risk factors between suture-based vs MANTA device closure.
Retrospective analysis of patients who underwent TAVI between December 2019 and September 2023 was performed. Logistic regression and propensity score matching was performed to ascertain risk factors for vascular complications post-TAVI.
Of the 1763 patients, there were 106 vascular complications (6%). There was a nonsignificant increased complication rate in MANTA vs suture-based device closure (8.3% vs 5.3%, p = 0.064). Among these, the most common complications were VCD failure (23%), pseudoaneurysm (20%) and arterial dissection (19%). Obesity (p = 0.021), anemia (p = 0.039) and MANTA device use (p = 0.027) were predictors of vascular complications. Within the MANTA cohort, novel oral anticoagulant (NOAC) use was predictive of vascular complications (p = 0.002). Among suture-based devices, obesity (p = 0.037) and anaemia (p = 0.017) were significant predictors. A propensity matched analysis derived 90 pairs of patients matched for age, gender, diabetes, peripheral arterial disease, NOAC use, anemia and obesity, identifying an average treatment effect of 0.039 (p = 0.04) when MANTA device closure was performed.
Vascular complications in TAVI remain common. Identifying predictors such as MANTA device closure, obesity, anemia, and baseline NOAC use will allow for improved risk stratification and appropriate VCD selection in patients undergoing TAVI.
经导管主动脉瓣置换术（TAVI）后血管并发症很常见。关于血管并发症预测因素的最新数据有限，特别是比较新型的基于塞子的设备与传统的基于缝合的血管闭合装置（VCD）。
主要目的是根据 VARC-3 标准确定 TAVI 患者发生血管并发症的风险较高的特征，特别是比较基于缝合与 MANTA 装置闭合的风险因素。
对 2019 年 12 月至 2023 年 9 月期间接受 TAVI 的患者进行回顾性分析。采用逻辑回归和倾向评分匹配来确定 TAVI 后血管并发症的危险因素。
在 1763 例患者中，有 106 例发生血管并发症（6%）。MANTA 与基于缝合的装置相比，并发症发生率无显著增加（8.3% vs 5.3%，p=0.064）。在这些并发症中，最常见的是 VCD 失败（23%）、假性动脉瘤（20%）和动脉夹层（19%）。肥胖症（p=0.021）、贫血（p=0.039）和 MANTA 装置的使用（p=0.027）是血管并发症的预测因素。在 MANTA 组中，新型口服抗凝剂（NOAC）的使用与血管并发症相关（p=0.002）。在基于缝合的装置中，肥胖症（p=0.037）和贫血（p=0.017）是显著的预测因素。通过倾向评分匹配分析得出了 90 对年龄、性别、糖尿病、外周动脉疾病、NOAC 使用、贫血和肥胖匹配的患者，当使用 MANTA 装置闭合时，平均治疗效果为 0.039（p=0.04）。
TAVI 后的血管并发症仍然很常见。识别 MANTA 装置闭合、肥胖症、贫血和基线时使用 NOAC 等预测因素，将有助于对接受 TAVI 的患者进行更好的风险分层和适当的 VCD 选择。
