■经导管主动脉瓣置换术(TAVR)期间的冠状动脉阻塞很少见,但却危及生命,并发症。在高危患者中,常规使用左主干(LM)保护带或不带支架放置仍存在争议。这项研究的目的是评估TAVR期间LM保护的结果,并确定与支架放置需要相关的解剖学因素。
■我们回顾性回顾了2014年至2019年在我们机构中进行的所有TAVR病例(天然和瓣膜中瓣膜),并确定了使用冠状动脉导线进行LM保护的患者。气球,和/或手术期间的支架。我们比较了TAVR计算机断层扫描前的主动脉根部特征,程序数据,short-,以及最终接受LM支架的患者和未接受LM支架的患者的长期结局。
■在1925名TAVR患者中,41(2.1%)接受了LM保护,其中10例(25%)最终在LM中放置了支架,用于瓣膜展开后的威胁阻塞。在原生TAVR组中(n=35),8例患者行LM支架置入术。更大的TAVR假体,较大的环形圆周(83.8对76.1毫米;P=0.038),窦管连接直径与假体尺寸的比值较低(1.02vs1.11;P=0.032),和较长的左冠状动脉尖(15.1vs13.9mm;P=.18)与LM支架置入的发生率较高相关。在瓣膜中TAVR组(n=6)中,5例患者的瓣膜与冠状动脉的距离小于4毫米,其中2人接受了LM支架。支架组和非支架组均有良好的预后,30天时无重大不良心血管事件或冠状动脉阻塞。经过351天的中位随访,4例患者死亡(9.7%)(支架组1例,非支架组3例),两组均无任何晚期冠状动脉阻塞或经皮冠状动脉介入治疗的病例。
■用冠状动脉导丝进行LM保护,气球,在适当选择的高危患者中,TAVR期间或支架是一种安全有效的冠状动脉保护方法。环形圆周,假体尺寸,左冠状动脉尖长度,LM口高度,窦管连接处与假体大小的比值是支架展开的重要预测因素。
UNASSIGNED: Coronary obstruction during transcatheter aortic valve replacement (TAVR) is a rare, yet life-threatening, complication. The routine use of left main (LM) protection with or without stent placement in high-risk patients remains controversial. The aim of this study was to evaluate the outcomes of LM protection during TAVR and identify anatomic factors associated with need for stent placement.
UNASSIGNED: We retrospectively reviewed all TAVR cases (native and valve-in-valve) performed in our institution between 2014 and 2019 and identified patients who underwent LM protection with a coronary wire, balloon, and/or stent during the procedure. We compared the pre-TAVR computed tomography aortic root characteristics, procedural data, short-, and long-term outcomes among the patients who eventually received an LM stent and those who did not.
UNASSIGNED: Among 1925 TAVR patients, 41 (2.1%) underwent LM protection, and 10 of them (25%) had eventually a stent placed in the LM for threatened obstruction after valve deployment. In the native TAVR group (n = 35), 8 patients underwent LM stenting. A larger TAVR prosthesis, larger annular circumference (83.8 vs 76.1 mm; P = .038), lower ratio of sinotubular junction diameter to prosthesis size (1.02 vs 1.11; P = .032), and longer left coronary cusp (15.1 vs 13.9 mm; P = .18) were associated with higher incidence of LM stenting. In the valve-in-valve TAVR group (n = 6), 5 patients had a valve-to-coronary distance of less than 4 mm, and 2 of them received an LM stent. Both stent and nonstent groups had excellent outcomes with no major adverse cardiovascular events or coronary obstruction at 30 days. After a median follow-up of 351 days, 4 patients died (9.7%) (1 in the stent and 3 in the nonstent group), without any cases of late coronary obstruction or percutaneous coronary intervention in either group.
UNASSIGNED: LM protection with a coronary guidewire, balloon, or stent is a safe and effective method of coronary protection during TAVR in appropriately selected high-risk patients. Annular circumference, prosthesis size, left coronary cusp length, LM ostial height, and ratio of sinotubular junction to prosthesis size are important predictors of stent deployment.