背景:经导管主动脉瓣植入术(TAVI)后血管并发症很常见。关于血管并发症预测因子的最新数据有限,特别是比较较新的基于插头的装置与传统的基于缝合的血管闭合装置(VCD)。
目的:主要目的是确定预测TAVI患者血管并发症风险较高的特征,根据VARC-3标准判断,特别是比较基于缝合线和MANTA装置闭合之间的风险因素。
方法:对2019年12月至2023年9月接受TAVI的患者进行回顾性分析。进行Logistic回归和倾向评分匹配以确定TAVI后血管并发症的危险因素。
结果:在1763名患者中,有106例血管并发症(6%).MANTA与基于缝合的装置闭合的并发症发生率无显著增加(8.3%vs5.3%,p=0.064)。其中,最常见的并发症是VCD失败(23%),假性动脉瘤(20%)和动脉夹层(19%)。肥胖(p=0.021),贫血(p=0.039)和使用MANTA器械(p=0.027)是血管并发症的预测因子.在曼塔队列中,新型口服抗凝剂(NOAC)的使用可预测血管并发症(p=0.002).在基于缝合的装置中,肥胖(p=0.037)和贫血(p=0.017)是显著的预测因子.倾向匹配分析得出90对年龄匹配的患者,性别,糖尿病,外周动脉疾病,NOAC使用,贫血和肥胖,当进行MANTA装置闭合时,确定平均治疗效果为0.039(p=0.04).
结论:TAVI血管并发症仍然很常见。识别预测因子,如MANTA设备关闭,肥胖,贫血,和基线NOAC的使用将有助于改善接受TAVI的患者的风险分层和适当的VCD选择。
BACKGROUND: Vascular complications post-transcatheter aortic valve implantation (TAVI) are common. Recent data regarding predictors of vascular complications are limited, particularly comparing newer plug-based devices versus traditional suture-based vascular closure devices (VCD).
OBJECTIVE: The primary objective was to identify characteristics that predict a higher risk of vascular complications in TAVI patients, as judged by the VARC-3 criteria, specifically comparing risk factors between suture-based vs MANTA device closure.
METHODS: Retrospective analysis of patients who underwent TAVI between December 2019 and September 2023 was performed. Logistic regression and propensity score matching was performed to ascertain risk factors for vascular complications post-TAVI.
RESULTS: Of the 1763 patients, there were 106 vascular complications (6%). There was a nonsignificant increased complication rate in MANTA vs suture-based device closure (8.3% vs 5.3%, p = 0.064). Among these, the most common complications were VCD failure (23%), pseudoaneurysm (20%) and arterial dissection (19%). Obesity (p = 0.021), anemia (p = 0.039) and MANTA device use (p = 0.027) were predictors of vascular complications. Within the MANTA cohort, novel oral anticoagulant (NOAC) use was predictive of vascular complications (p = 0.002). Among suture-based devices, obesity (p = 0.037) and anaemia (p = 0.017) were significant predictors. A propensity matched analysis derived 90 pairs of patients matched for age, gender, diabetes, peripheral arterial disease, NOAC use, anemia and obesity, identifying an average treatment effect of 0.039 (p = 0.04) when MANTA device closure was performed.
CONCLUSIONS: Vascular complications in TAVI remain common. Identifying predictors such as MANTA device closure, obesity, anemia, and baseline NOAC use will allow for improved risk stratification and appropriate VCD selection in patients undergoing TAVI.