JACC: Cardiovascular Interventions ( IF 11.7 ) Pub Date : 2023-05-22 , DOI: 10.1016/j.jcin.2023.03.024 Soledad Ojeda 1 , Rafael González-Manzanares 2 , Pilar Jiménez-Quevedo 3 , Pablo Piñón 4 , Lluis Asmarats 5 , Ignacio Amat-Santos 6 , Eduard Fernández-Nofrerias 7 , Raquel Del Valle 8 , Erika Muñoz-García 9 , Maria-Cruz Ferrer-Gracia 10 , Jose María de la Torre 11 , Valeriano Ruiz-Quevedo 12 , Ander Regueiro 13 , Dario Sanmiguel 14 , Sergio García-Blas 15 , Jaime Elízaga 16 , Jose Antonio Baz 17 , Rafael Romaguera 18 , Ignacio Cruz-González 19 , José Moreu 20 , Livia L Gheorghe 21 , Luisa Salido 22 , Raúl Moreno 23 , Cristóbal Urbano 24 , Vicenc Serra 25 , Manuel Pan 1
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Background
Coronary obstruction (CO) following transcatheter aortic valve replacement (TAVR) is a life-threatening complication, scarcely studied.
Objectives
The authors analyzed the incidence of CO after TAVR, presentation, management, and in-hospital and 1-year clinical outcomes in a large series of patients undergoing TAVR.
Methods
Patients from the Spanish TAVI (Transcatheter Aortic Valve Implantation) registry who presented with CO in the procedure, during hospitalization or at follow-up were included. Computed tomography (CT) risk factors were assessed. In-hospital, 30-day, and 1-year all-cause mortality rates were analyzed and compared with patients without CO using logistic regression models in the overall cohort and in a propensity score-matched cohort.
Results
Of 13,675 patients undergoing TAVR, 115 (0.80%) presented with a CO, mainly during the procedure (83.5%). The incidence of CO was stable throughout the study period (2009-2021), with a median annual rate of 0.8% (range 0.3%-1.3%). Preimplantation CT scans were available in 105 patients (91.3%). A combination of at least 2 CT-based risk factors was less frequent in native than in valve-in-valve patients (31.7% vs 78.3%; P < 0.01). Percutaneous coronary intervention was the treatment of choice in 100 patients (86.9%), with a technical success of 78.0%. In-hospital, 30-day, and 1-year mortality rates were higher in CO patients than in those without CO (37.4% vs 4.1%, 38.3% vs 4.3%, and 39.1% vs 9.1%, respectively; P < 0.001).
Conclusions
In this large, nationwide TAVR registry, CO was a rare, but often fatal, complication that did not decrease over time. The lack of identifiable predisposing factors in a subset of patients and the frequently challenging treatment when established may partly explain these findings.
中文翻译：
经导管主动脉瓣置换术后的冠状动脉梗阻：来自西班牙 TAVI 登记处的见解
背景
经导管主动脉瓣置换术 (TAVR ) 后的冠状动脉阻塞 (CO ) 是一种危及生命的并发症，研究很少。
目标
作者分析了接受 TAVR 的大量患者的 TAVR 后 CO 的发生率、表现、管理以及住院和 1 年临床结果。
方法
来自西班牙 TAVI（经导管主动脉瓣植入术）注册的患者在手术过程中、住院期间或随访期间出现 CO。评估了计算机断层扫描 (CT) 风险因素。在整个队列和倾向评分匹配队列中，使用逻辑回归模型分析院内、30 天和 1 年全因死亡率，并与无 CO 的患者进行比较。
结果
在接受 TAVR 的 13,675 名患者中，115 名 (0.80%) 出现 CO，主要是在手术期间 (83.5%)。CO 的发病率在整个研究期间（2009-2021 年）保持稳定，中位年增长率为 0.8%（范围 0.3%-1.3%）。105 名患者 (91.3%) 进行了植入前 CT 扫描。至少 2 个基于 CT 的危险因素的组合在本地患者中的发生率低于瓣中瓣患者（31.7% 对 78.3%；P < 0.01）。100 名患者 (86.9%) 选择经皮冠状动脉介入治疗，技术成功率为 78.0%。CO 患者的住院、30 天和 1 年死亡率高于无 CO 患者（分别为 37.4% 对 4.1%、38.3% 对 4.3% 和 39.1% 对 9.1%；P < 0.001 ） .
结论
在这个大型的全国性 TAVR 登记中，CO 是一种罕见但通常致命的并发症，并没有随着时间的推移而减少。部分患者缺乏可识别的易感因素以及确定后经常接受具有挑战性的治疗可能部分解释了这些发现。
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