Impact of Aortic Atherosclerosis on Clinical Outcomes After Transfemoral Transcatheter Aortic Valve Replacement

IF 1.9 3区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Catheterization and Cardiovascular Interventions Pub Date : 2025-08-25 DOI:10.1002/ccd.70125

Yoshinori Shirai, Akihito Tanaka, Yoshiyuki Tokuda, Hiroki Kondo, Koji Mizutani, Tomonari Uemura, Kenji Furusawa, Masato Mutsuga, Toyoaki Murohara

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Abstract

Background

Aortic atherothrombotic lesions can cause systemic embolization and adverse outcomes after interventional procedures.

Aims

This study aimed to assess the association between the degree of aortic atherosclerosis and clinical outcomes after transfemoral transcatheter aortic valve replacement (TAVR).

Methods

This single-center observational study included data from 278 patients who underwent transfemoral TAVR. The degree of aortic atherosclerosis in the ascending aorta, aortic arch, descending aorta, and abdominal aorta according to preoperative enhanced computed tomography was evaluated, and extensive intimal thickening ≥ 4 mm or mobile-looking, ulcerated or protruding atheroma were considered to be atherothrombotic lesions. Patients were classified into two groups: those with and without atherothrombotic lesions. Clinical outcomes, including all-cause death, stroke, systemic embolization, and worsening renal function, were investigated.

Results

Of 278 patients, 116 (41.4%) exhibited atherothrombotic lesions. Baseline renal function was significantly worse in patients with atherothrombotic lesions. There were no significant differences in the occurrence of all-cause death (0% vs. 0.6%; p > 0.99), stroke (3.5% vs. 2.5%; p = 0.72), systemic embolism (0.9% vs. 0%; p = 0.42), and worsening renal function (increase in serum creatinine ≥ 0.3 mg/dL or ≥ 1.5-fold from baseline; 5.4% vs. 5.2%; p = 0.93) within 1-month. During a median follow-up of 3.0 years (interquartile range 2.0–4.0 years), the occurrence of all-cause death was numerically higher in patients with atherothrombotic lesions compared to those without.

Conclusions

Atherothrombotic lesions were commonly observed in patients undergoing transfemoral TAVR. No significant clinical effect of aortic atherosclerosis on short-term adverse outcomes was observed, although long-term mortality was numerically higher in patients who exhibited atherothrombotic lesions.

Abstract Image

查看原文本刊更多论文

经股动脉粥样硬化对经导管主动脉瓣置换术后临床结果的影响。

背景：主动脉动脉粥样硬化性血栓病变可引起全身栓塞和介入手术后的不良后果。目的：本研究旨在评估经股经导管主动脉瓣置换术（TAVR）后主动脉粥样硬化程度与临床预后的关系。方法：这项单中心观察性研究纳入了278例经股TAVR患者的数据。术前增强ct评估升主动脉、主动脉弓、降主动脉、腹主动脉动脉粥样硬化程度，广泛的内膜增厚≥4mm或有移动样、溃疡或突出的动脉粥样硬化视为动脉粥样硬化性病变。患者分为两组：有和没有动脉粥样硬化血栓病变。临床结果包括全因死亡、中风、全身栓塞和肾功能恶化。结果：278例患者中，116例（41.4%）出现动脉粥样硬化性病变。动脉粥样硬化性血栓病变患者的基线肾功能明显更差。1个月内全因死亡（0%对0.6%;p < 0.99）、卒中（3.5%对2.5%;p = 0.72）、全身栓塞（0.9%对0%；p = 0.42）和肾功能恶化（血清肌酐升高≥0.3 mg/dL或≥1.5倍于基线；5.4%对5.2%;p = 0.93）的发生率无显著差异。在中位随访3.0年（四分位数范围2.0-4.0年）期间，动脉粥样硬化性血栓病变患者的全因死亡发生率高于无动脉粥样硬化性血栓病变患者。结论：动脉粥样硬化性血栓病变常见于经股TAVR患者。没有观察到主动脉粥样硬化对短期不良结局的显著临床影响，尽管表现出动脉粥样硬化血栓病变的患者的长期死亡率在数字上更高。

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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.