Transcatheter aortic valve replacement in patients with preoperative ascending aortic diameter ≥45 mm.

IF 2.1 3区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Cardiovascular diagnosis and therapy Pub Date : 2023-12-15 Epub Date: 2023-12-08 DOI:10.21037/cdt-23-324
Kang An, Fengwen Zhang, Wenbin Ouyang, Xiangbin Pan
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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.

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术前主动脉升主动脉直径≥45毫米患者的经导管主动脉瓣置换术。
背景:目前,接受主动脉瓣置换术的患者同时接受升主动脉(AA)置换术的指征是 AA 直径超过 45 毫米。然而,AA扩张(≥45毫米)对经导管主动脉瓣置换术(TAVR)患者的影响仍不清楚:我们对 2016 年 1 月至 2021 年 4 月期间接受经股动脉 TAVR 的 467 例连续患者进行了回顾性评估。进行了 Cox 比例危险回归,以确定全因死亡率的风险因素。主要终点是全因死亡率,次要终点是主动脉夹层和/或破裂的发生率:100名患者(21.4%)术前AA≥45毫米。AA≥45毫米患者的中位年龄为73岁,AA患者的中位年龄为75岁(78.3%±6.8%,P=0.198)。只有一名 AA 患者 结论:术前AA≥45 mm的患者可以安全地进行经股动脉TAVR,且术中风险较低。AA≥45毫米似乎不会影响中期生存,主动脉不良事件也很少发生。
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来源期刊
Cardiovascular diagnosis and therapy
Cardiovascular diagnosis and therapy Medicine-Cardiology and Cardiovascular Medicine
CiteScore
4.90
自引率
4.20%
发文量
45
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.
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