Kang An, Fengwen Zhang, Wenbin Ouyang, Xiangbin Pan
{"title":"Transcatheter aortic valve replacement in patients with preoperative ascending aortic diameter ≥45 mm.","authors":"Kang An, Fengwen Zhang, Wenbin Ouyang, Xiangbin Pan","doi":"10.21037/cdt-23-324","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Current indication for concomitant replacement of ascending aorta (AA) in patients undergoing surgical aortic valve replacement is that AA diameter exceeds 45 mm. However, the impact of AA dilation (≥45 mm) in patients undergoing transcatheter aortic valve replacement (TAVR) remains unclear.</p><p><strong>Methods: </strong>We retrospectively evaluated 467 consecutive patients who underwent transfemoral TAVR from January 2016 to April 2021. Cox proportional hazards regression was performed to identify risk factors for all-cause mortality. The primary endpoint was the all-cause mortality, and the secondary endpoints were the occurrence of the aortic dissection and/or rupture.</p><p><strong>Results: </strong>One hundred patients (21.4%) presented preoperative AA ≥45 mm. The median age was 73 years for patients with AA ≥45 mm and 75 years for patients with AA <45 mm (P=0.021). The in-hospital mortality rate was 1.1%. There was no iatrogenic injury to the AA. Only one patient (0.2%) in AA <45 mm group experienced retrograde type B aortic dissection in the descending aorta. The median follow-up was 19 [16-34] months in patients with AA ≥45 mm and 27 [15-37] months in patients with AA <45 mm (P=0.152). No statistical difference was found between the two groups regarding the overall survival (92.5%±3.5% <i>vs.</i> 78.3%±6.8%, P=0.198). Only one patient in AA <45 mm group experienced type A aortic dissection 10 months after the procedure. In both univariable and multivariable analysis, AA ≥45 mm was not an independent predictor for all-cause mortality.</p><p><strong>Conclusions: </strong>Transfemoral TAVR can be performed safely in patients with preoperative AA ≥45 mm with a low intraprocedural risk. The mid-term survival appears not to be affected by the presence of AA ≥45 mm, and adverse aortic events are rare.</p>","PeriodicalId":9592,"journal":{"name":"Cardiovascular diagnosis and therapy","volume":"13 6","pages":"939-947"},"PeriodicalIF":2.1000,"publicationDate":"2023-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10753242/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Cardiovascular diagnosis and therapy","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.21037/cdt-23-324","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2023/12/8 0:00:00","PubModel":"Epub","JCR":"Q3","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
引用次数: 0
Abstract
Background: Current indication for concomitant replacement of ascending aorta (AA) in patients undergoing surgical aortic valve replacement is that AA diameter exceeds 45 mm. However, the impact of AA dilation (≥45 mm) in patients undergoing transcatheter aortic valve replacement (TAVR) remains unclear.
Methods: We retrospectively evaluated 467 consecutive patients who underwent transfemoral TAVR from January 2016 to April 2021. Cox proportional hazards regression was performed to identify risk factors for all-cause mortality. The primary endpoint was the all-cause mortality, and the secondary endpoints were the occurrence of the aortic dissection and/or rupture.
Results: One hundred patients (21.4%) presented preoperative AA ≥45 mm. The median age was 73 years for patients with AA ≥45 mm and 75 years for patients with AA <45 mm (P=0.021). The in-hospital mortality rate was 1.1%. There was no iatrogenic injury to the AA. Only one patient (0.2%) in AA <45 mm group experienced retrograde type B aortic dissection in the descending aorta. The median follow-up was 19 [16-34] months in patients with AA ≥45 mm and 27 [15-37] months in patients with AA <45 mm (P=0.152). No statistical difference was found between the two groups regarding the overall survival (92.5%±3.5% vs. 78.3%±6.8%, P=0.198). Only one patient in AA <45 mm group experienced type A aortic dissection 10 months after the procedure. In both univariable and multivariable analysis, AA ≥45 mm was not an independent predictor for all-cause mortality.
Conclusions: Transfemoral TAVR can be performed safely in patients with preoperative AA ≥45 mm with a low intraprocedural risk. The mid-term survival appears not to be affected by the presence of AA ≥45 mm, and adverse aortic events are rare.
期刊介绍:
The journal ''Cardiovascular Diagnosis and Therapy'' (Print ISSN: 2223-3652; Online ISSN: 2223-3660) accepts basic and clinical science submissions related to Cardiovascular Medicine and Surgery. The mission of the journal is the rapid exchange of scientific information between clinicians and scientists worldwide. To reach this goal, the journal will focus on novel media, using a web-based, digital format in addition to traditional print-version. This includes on-line submission, review, publication, and distribution. The digital format will also allow submission of extensive supporting visual material, both images and video. The website www.thecdt.org will serve as the central hub and also allow posting of comments and on-line discussion. The web-site of the journal will be linked to a number of international web-sites (e.g. www.dxy.cn), which will significantly expand the distribution of its contents.