Coronary angiography following transcatheter aortic valve replacement: Insights from the SWEDEHEART registry

IF 2.1 3区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Catheterization and Cardiovascular Interventions Pub Date : 2024-07-31 DOI:10.1002/ccd.31171

Antros Louca MD, Monér Alchay MD, Truls Råmunddal MD, PhD, Araz Rawshani MD, PhD, Henrik Hagström MD, PhD, Magnus Settergren MD, PhD, Konrad Nilsson MD, PhD, Bahira Shahim MD, PhD, Stefan James MD, PhD, Sasha Koul MD, PhD, Anna Myredal MD, PhD, Björn Redfors MD, PhD, Dan Ioanes MD, PhD, Sebastian Völz MD, PhD, Petur Petursson MD, PhD, Oskar Angerås MD, PhD

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引用次数: 0

Abstract

Background

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.

Objectives

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.

Methods

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.

Results

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.

Conclusions

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

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经导管主动脉瓣置换术后的冠状动脉造影：来自 SWEDEHEART 登记的启示。

背景：经导管主动脉瓣置换术（TAVR）是无症状重度主动脉瓣狭窄（AS）患者最常见的治疗方法。由于主动脉瓣狭窄患者常合并冠状动脉疾病，TAVR术后冠状动脉的通路变得越来越重要：本研究评估了 TAVR 术后非计划冠状动脉造影的发生率和风险因素，并以透视时间作为替代指标，分析了冠状动脉插管的复杂性：方法：通过 SWEDEHEART 登记系统识别了 2008 年至 2022 年间在瑞典接受 TAVR 的所有患者。以死亡率作为竞争风险，分析了 TAVR 术后冠状动脉造影的累积发生率。利用透视时间分析了血管造影和PCI的复杂性，并对不同的经导管心脏瓣膜设计进行了比较：结果：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。年龄越小、既往冠状动脉疾病程度越高以及外周血管疾病与冠状动脉造影风险增加有关。与对照组相比，TAVR患者的透视时间增加，其中涉及环上瓣膜和自扩张瓣膜的病例透视时间最长：结论：TAVR术后冠状动脉造影的发生率仍然很低。结论：TAVR术后冠状动脉造影的发生率仍然很低，年轻患者和合并冠状动脉疾病的患者风险更高。曾置换过THV的患者手术时间更长。由于 TAVR 正在成为预期寿命较长患者的一线治疗方法，因此在考虑植入哪种 THV 设备时，方便冠状动脉通路是一个重要因素。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Catheterization and Cardiovascular Interventions 医学-心血管系统

CiteScore

5.40

自引率

8.70%

发文量

419

审稿时长

2 months

期刊介绍： Catheterization and Cardiovascular Interventions is an international journal covering the broad field of cardiovascular diseases. Subject material includes basic and clinical information that is derived from or related to invasive and interventional coronary or peripheral vascular techniques. The journal focuses on material that will be of immediate practical value to physicians providing patient care in the clinical laboratory setting. To accomplish this, the journal publishes Preliminary Reports and Work In Progress articles that complement the traditional Original Studies, Case Reports, and Comprehensive Reviews. Perspective and insight concerning controversial subjects and evolving technologies are provided regularly through Editorial Commentaries furnished by members of the Editorial Board and other experts. Articles are subject to double-blind peer review and complete editorial evaluation prior to any decision regarding acceptability.