Feasibility of coronary access after transcatheter aortic valve implantation (TAVI): a systematic review and meta-analysis of observational studies.

IF 4.6 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS
Federico Giacobbe, Arianna Morena, Francesco Bruno, Marco Nebiolo, Ovidio De Filippo, Yasser Odeh, Gianluca Di Pietro, Josep Rodes Cabau, Federico Conrotto, Annapoorna Kini, Giuseppe Giannino, Azeem Latib, Pierluigi Omedé, Stephane Noble, Michele William La Torre, Marco Barbanti, Giuseppe Tarantini, Won-Keun Kim, Johannes Blumenstein, Madjid Boukantar, Wan Wan Htun, Gaetano Maria de Ferrari, Stefano Salizzoni, Fabrizio D'Ascenzo
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引用次数: 0

Abstract

Introduction: The expanding indications for transcatheter aortic valve implantation (TAVI) to younger, lower-risk patients, entails assessing not only the short-term clinical outcomes but also the long-term considerations for future interventions. The prevalence of coronary artery disease in TAVI patients is relevant, and the optimal timing of percutaneous coronary intervention remains a question.

Methods and results: We conducted a systematic literature review and meta-analysis including 20 eligible studies involving 1660 patients who underwent coronary angiography after TAVI. The primary endpoint was the incidence of successful selective coronary re-access. Secondary endpoints included semi-selective and non-selective access rates. The analysis was stratified by balloon-expandable (BEVs) and self-expandable valve (SEVs) types. Successful coronary access after TAVI was feasible in the majority of patients, with a higher success rate observed for the left main (LM) compared to the right coronary artery (RCA). BEVs demonstrated the highest success rates in coronary ostia cannulation, achieving nearly 100% success for both LM and RCA. Among SEVs, the Acurate Neo and Evolut R/PRO showed superior success rates in selective coronary access (68 and 77% for LM; 57 and 72% for RCA, respectively) compared to the CoreValve (46% for LM and 49% for RCA). Notably, the majority of coronary angiograms were performed due to acute coronary syndrome, primarily non-ST-segment elevation myocardial infarction, and unstable angina.

Conclusion: Selective coronary engagement after TAVI is generally achievable, with BEVs demonstrating superior success rates compared to SEVs. Among SEVs, the Acurate NEO showed better outcomes than the other types.

经导管主动脉瓣植入术(TAVI)后冠状动脉通路的可行性:一项观察性研究的系统回顾和meta分析。
导言:经导管主动脉瓣植入术(TAVI)的适应症不断扩大,不仅需要评估短期临床结果,还需要对未来干预措施的长期考虑。冠状动脉疾病(CAD)在TAVI患者中的患病率是相关的,而经皮冠状动脉介入治疗(PCI)的最佳时机仍然是一个问题。方法:我们进行了系统的文献综述和meta分析,包括20项符合条件的研究,涉及1660例TAVI后接受冠状动脉造影的患者。主要终点是成功的选择性冠状动脉再通路的发生率。次要终点包括半选择性和非选择性接入率。分析分为球囊膨胀阀(bev)和自膨胀阀(sev)两种类型。结果:大多数患者在TAVI后冠脉通路成功,其中左主干(LM)的成功率高于右冠状动脉(RCA)。bev在冠脉口插管中成功率最高,在LM和RCA中均达到近100%的成功率。在sev中,precision Neo和Evolut R/PRO在选择性冠状动脉通路中显示出更高的成功率(LM为68%和77%;RCA的比例分别为57%和72%),而CoreValve (LM为46%,RCA为49%)。值得注意的是,大多数冠状动脉造影是由于急性冠状动脉综合征进行的,主要是非st段抬高型心肌梗死(NSTEMI)和不稳定型心绞痛(UA)。结论:TAVI术后选择性冠脉介入通常是可以实现的,bev的成功率高于sev。在sev中,accurate NEO表现出比其他类型更好的结果。
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
CiteScore
9.40
自引率
3.80%
发文量
76
期刊介绍: European Heart Journal - Quality of Care & Clinical Outcomes is an English language, peer-reviewed journal dedicated to publishing cardiovascular outcomes research. It serves as an official journal of the European Society of Cardiology and maintains a close alliance with the European Heart Health Institute. The journal disseminates original research and topical reviews contributed by health scientists globally, with a focus on the quality of care and its impact on cardiovascular outcomes at the hospital, national, and international levels. It provides a platform for presenting the most outstanding cardiovascular outcomes research to influence cardiovascular public health policy on a global scale. Additionally, the journal aims to motivate young investigators and foster the growth of the outcomes research community.
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