PDF(Pubmed)
Abstract：
UNASSIGNED: Coronary obstruction following transcatheter aortic valve replacement (TAVR) is a life-threatening complication. For patients at elevated risk, it is not known how valve choice is influenced by clinical and anatomic factors and how outcomes differ between valve platforms. For patients at high risk of coronary obstruction, we sought to describe the anatomical and clinical characteristics of patients treated with both balloon-expandable (BE) and self-expanding (SE) valves.
UNASSIGNED: This was a multicenter international registry of patients undergoing TAVR who are considered to be at high risk of coronary obstruction and receiving pre-emptive coronary protection.
UNASSIGNED: A total of 236 patients were included. Patients receiving SE valves were more likely to undergo valve-in-valve procedures and also had smaller sinuses of Valsalva and valve-to-coronary distance. Three-year cardiac mortality was 21.6% with SE vs 3.7% with BE valves. This was primarily driven by increased rates of definite or probable coronary occlusion, which occurred in 12.1% of patients with SE valves vs 2.1% in patients with BE valves.
UNASSIGNED: In patients undergoing TAVR with coronary protection, those treated with SE valves had increased rates of clinical and anatomic features that increase the risk of coronary obstruction. These include an increased frequency of valve-in-valve procedures, smaller sinuses of Valsalva, and smaller valve-to-coronary distances. These patients were observed to have increased cardiac mortality compared with patients treated with BE valves, but this is likely due to their higher risk clinical and anatomic phenotypes rather than as a function of the valve type itself.
UNASSIGNED: This was a multicenter international registry of patients undergoing TAVR who are considered to be at high risk of coronary obstruction and receiving pre-emptive coronary protection.
UNASSIGNED: A total of 236 patients were included. Patients receiving SE valves were more likely to undergo valve-in-valve procedures and also had smaller sinuses of Valsalva and valve-to-coronary distance. Three-year cardiac mortality was 21.6% with SE vs 3.7% with BE valves. This was primarily driven by increased rates of definite or probable coronary occlusion, which occurred in 12.1% of patients with SE valves vs 2.1% in patients with BE valves.
UNASSIGNED: In patients undergoing TAVR with coronary protection, those treated with SE valves had increased rates of clinical and anatomic features that increase the risk of coronary obstruction. These include an increased frequency of valve-in-valve procedures, smaller sinuses of Valsalva, and smaller valve-to-coronary distances. These patients were observed to have increased cardiac mortality compared with patients treated with BE valves, but this is likely due to their higher risk clinical and anatomic phenotypes rather than as a function of the valve type itself.
摘要：
■经导管主动脉瓣置换术（TAVR）后冠状动脉阻塞是一种危及生命的并发症。对于高风险的患者，目前尚不清楚瓣膜的选择如何受到临床和解剖因素的影响,以及不同瓣膜平台的结局有何不同.对于冠状动脉阻塞高风险的患者，我们试图描述球囊扩张型(BE)和自扩张型(SE)瓣膜治疗患者的解剖学和临床特征.
■这是接受TAVR的患者的多中心国际注册，这些患者被认为处于冠状动脉阻塞的高风险并接受了先发制人的冠状动脉保护。
■共纳入236例患者。接受SE瓣膜的患者更有可能接受瓣膜中瓣膜手术，并且Valsalva窦和瓣膜到冠状动脉的距离也较小。SE的三年心脏死亡率为21.6％，BE瓣膜的死亡率为3.7％。这主要是由于明确或可能的冠状动脉闭塞率增加所致，发生在SE瓣膜患者中的12.1%比BE瓣膜患者中的2.1%。
■在接受冠状动脉保护的TAVR患者中，接受SE瓣膜治疗的患者的临床和解剖学特征增加了冠状动脉阻塞的风险.这些措施包括增加阀门对阀程序的频率，较小的Valsalva窦,和较小的瓣膜到冠状动脉的距离。与接受BE瓣膜治疗的患者相比，这些患者的心脏死亡率增加。但这可能是由于它们的临床和解剖表型风险较高，而不是瓣膜类型本身的功能。
■这是接受TAVR的患者的多中心国际注册，这些患者被认为处于冠状动脉阻塞的高风险并接受了先发制人的冠状动脉保护。
■共纳入236例患者。接受SE瓣膜的患者更有可能接受瓣膜中瓣膜手术，并且Valsalva窦和瓣膜到冠状动脉的距离也较小。SE的三年心脏死亡率为21.6％，BE瓣膜的死亡率为3.7％。这主要是由于明确或可能的冠状动脉闭塞率增加所致，发生在SE瓣膜患者中的12.1%比BE瓣膜患者中的2.1%。
■在接受冠状动脉保护的TAVR患者中，接受SE瓣膜治疗的患者的临床和解剖学特征增加了冠状动脉阻塞的风险.这些措施包括增加阀门对阀程序的频率，较小的Valsalva窦,和较小的瓣膜到冠状动脉的距离。与接受BE瓣膜治疗的患者相比，这些患者的心脏死亡率增加。但这可能是由于它们的临床和解剖表型风险较高，而不是瓣膜类型本身的功能。
