Vascular Complications After Transcatheter Aortic Valve Replacement

被引：422

作者：

Genereux, Philippe ^{[1
,2
]}

Webb, John G. ^{[3
]}

Svensson, Lars G. ^{[4
]}

Kodali, Susheel K. ^{[1
,2
]}

Satler, Lowell F. ^{[5
]}

Fearon, William F. ^{[6
]}

Davidson, Charles J. ^{[7
]}

Eisenhauer, Andrew C. ^{[8
]}

Makkar, Raj R. ^{[9
]}

Bergman, Geoffrey W. ^{[10
]}

Babaliaros, Vasilis ^{[11
]}

Bavaria, Joseph E. ^{[12
]}

Velazquez, Omaida C. ^{[13
]}

Williams, Mathew R. ^{[1
,2
]}

Hueter, Irene ^{[2
,14
]}

Xu, Ke ^{[1
,2
]}

Leon, Martin B. ^{[1
,2
]}

机构：

[1] Columbia Univ, Med Ctr, New York Presbyterian Hosp, New York, NY 10032 USA

[2] Cardiovasc Res Fdn, New York, NY USA

[3] Univ British Columbia, St Pauls Hosp, Vancouver, BC V5Z 1M9, Canada

[4] Cleveland Clin, Dept Thorac & Cardiovasc Surg, Cleveland, OH 44106 USA

[5] Medstar Washington Hosp Ctr, Washington, DC USA

[6] Stanford Univ, Med Ctr, Div Cardiovasc Med, Stanford, CA 94305 USA

[7] Northwestern Univ, NW Mem Hosp, Feinberg Sch Med, Bluhm Cardiovasc Inst, Chicago, IL 60611 USA

[8] Brigham & Womens Hosp, Boston, MA 02115 USA

[9] Cedars Sinai Heart Inst, Los Angeles, CA USA

[10] New York Presbyterian Hosp, Weill Cornell Med Ctr, New York, NY USA

[11] Emory Univ Hosp, Atlanta, GA 30322 USA

[12] Univ Penn, Div Cardiovasc Surg, Philadelphia, PA 19104 USA

[13] Univ Miami, Miller Sch Med, Miami, FL 33136 USA

[14] Columbia Univ, Dept Stat, New York, NY 10032 USA

来源：

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY | 2012年 / 60卷 / 12期

关键词：

aortic stenosis; TAVI; TAVR; vascular complication; HIGH-RISK PATIENTS; ACADEMIC RESEARCH CONSORTIUM; EDWARDS SAPIEN(TM); CLINICAL-OUTCOMES; LEARNING-CURVE; IMPLANTATION; STENOSIS; DEFINITIONS; EXPERIENCE; IMPACT;

D O I：

10.1016/j.jacc.2012.07.003

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Objectives This study sought to identify incidence, predictors, and impact of vascular complications (VC) after transfemoral (TF) transcatheter aortic valve replacement (TAVR). Background VC after TF-TAVR are frequent and may be associated with unfavorable prognosis. Methods From the randomized controlled PARTNER (Placement of AoRTic TraNscathetER Valve) trial, a total of 419 patients (177 from cohort B [inoperable] and 242 from cohort A [operable high-risk]) were randomly assigned to TF-TAVR and actually received the designated treatment. First-generation Edwards-Sapien valves and delivery systems were used, via a 22- or 24-F sheath. The 30-day rates of major and minor VC (modified Valve Academic Research Consortium definitions), predictors, and effect on 1-year mortality were assessed. Results Sixty-four patients (15.3%) had major VC and 50 patients (11.9%) had minor VC within 30 days of the procedure. Among patients with major VC, vascular dissection (62.8%), perforation (31.3%), and access-site hematoma (22.9%) were the most frequent modes of presentation. Major VC, but not minor VC, were associated with significantly higher 30-day rates of major bleeding, transfusions, and renal failure requiring dialysis, and with a significantly higher rate of 30-day and 1-year mortality. The only identifiable independent predictor of major VC was female gender (hazard ratio [HR]: 2.31 [95% confidence interval (CI): 1.08 to 4.98], p = 0.03). Major VC (HR: 2.31 [95% CI: 1.20 to 4.43], p = 0.012), and renal disease at baseline (HR: 2.26 [95% CI: 1.34 to 3.81], p = 0.002) were identified as independent predictors of 1-year mortality. Conclusions Major VC were frequent after TF-TAVR in the PARTNER trial using first-generation devices and were associated with high mortality. However, the incidence and impact of major VC on 1-year mortality decreased with lower-risk populations. (J Am Coll Cardiol 2012;60:1043-52) (c) 2012 by the American College of Cardiology Foundation

引用

页码：1043 / 1052

页数：10

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