Berres Dinah Maria, Schlömicher Markus, Dickmann Boris, Buck Thomas, Strauch Justus Thomas, Ahmad Farhan, Coman Horatiu, Haldenwang Peter Lukas
Department of Cardiothoracic Surgery, BG University Hospital Bergmannsheil Ruhr-University of Bochum, Bürkle de la Camp-Platz 1, 44789, Bochum, Germany.
Department of Cardiology, Marien Hospital Witten, Witten, Germany.
J Cardiothorac Surg. 2025 Apr 2;20(1):177. doi: 10.1186/s13019-025-03407-9.
Vascular (VC) and cardiac structural complications (CSC) are frequent complications following transcatheter aortic valve implantation (TAVI). Aim of this single-center retrospective study was to evaluate strategies for minimizing periprocedural access complications as part of an interdisciplinary structural heart program.
Included were all patients who underwent TAVI between 09/2022 and 08/2023 at our institution. All procedures were performed by a heart team, consisting of a cardiovascular surgeon with peripheral vascular and interventional experience and an interventional cardiologist on site. Valvular type and size, access route and backup strategies were assessed by the heart team according to the preoperative CT-imaging. Baseline characteristics, periprocedural data, complications and 30-day outcomes were analyzed concerning the access route using Mann-Whitney-U-test or Fisher´s exact test.
Analyzed were 167 consecutive patients (81 (76-85) years; 53.3% male). 48 (28.7%) of these had severe peripheral artery disease. 130 (77.8%) procedures were performed via a percutaneous transfemoral approach, 13 (7.8%) via a femoral cut-down and 4 (2.4%) via a transaxillary access. For 20 procedures (11.9%) a transapical access was used. 106 patients (72%) with transvascular and all patients with transapical access received a balloon-expanding valve, whereas 41 (28%) patients with transvascular access received a self-expanding prosthesis. No coronary occlusion was seen. Annular rupture occurred in one patient (0.6%), valve displacement in two patients (1.2%). Totally 5 (3%) access femoral arteries were stented and 8 (4.8%) needed a surgical reconstruction. 30-day mortality was 2.99%.
On site interventional and cardiovascular surgical expertise may minimize VC and CSC following TAVI.
血管并发症（VC）和心脏结构并发症（CSC）是经导管主动脉瓣植入术（TAVI）后的常见并发症。这项单中心回顾性研究的目的是评估作为跨学科结构性心脏病项目一部分的围手术期减少穿刺并发症的策略。
纳入2022年9月至2023年8月在我们机构接受TAVI的所有患者。所有手术均由心脏团队进行，该团队由具有外周血管和介入经验的心血管外科医生以及现场介入心脏病专家组成。心脏团队根据术前CT成像评估瓣膜类型和大小、穿刺途径和备用策略。使用Mann-Whitney-U检验或Fisher精确检验分析穿刺途径的基线特征、围手术期数据、并发症和30天结局。
分析了167例连续患者（年龄81（76 - 85）岁；男性占53.3%）。其中48例（28.7%）患有严重外周动脉疾病。130例（77.8%）手术通过经皮股动脉途径进行，13例（7.8%）通过股动脉切开术进行，4例（2.4%）通过经腋动脉途径进行。20例（11.9%）手术使用经心尖途径。106例（72%）经血管途径患者和所有经心尖途径患者接受球囊扩张瓣膜，而41例（28%）经血管途径患者接受自膨胀假体。未观察到冠状动脉闭塞。1例患者（0.6%）发生瓣环破裂，2例患者（1.2%）发生瓣膜移位。总共5例（3%）穿刺股动脉进行了支架置入，8例（4.8%）需要手术重建。30天死亡率为2.99%。
现场介入和心血管外科专业知识可能会减少TAVI后的VC和CSC。
