1. Assessing the Impact of Transcatheter Aortic Valve Implantation on Cardiac Catheterisation: A Multicentric Study
- Author
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Hsien-Li Kao, Maurizio Tespili, Iván J. Núñez Gil, Edgar Tay, Carlo Francisco Santos Gochuico, Yinghao Lim, Jonathan Yap, Fabrizio D'Ascenzo, Mao-Shin Lin, Alfonso Ielasi, Kay Woon Ho, Alessandro Depaoli, Alex Fernando Castro Mejía, and Michael Kang-Yin Lee
- Subjects
Male ,Pulmonary and Respiratory Medicine ,Coronary angiography ,Cardiac Catheterization ,medicine.medical_specialty ,Transcatheter aortic ,Cardiac catheterisation ,030204 cardiovascular system & hematology ,Prosthesis Design ,Logistic regression ,Transcatheter Aortic Valve Replacement ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Humans ,Medicine ,030212 general & internal medicine ,Aged ,Retrospective Studies ,medicine.diagnostic_test ,business.industry ,Mean age ,Retrospective cohort study ,Aortic Valve Stenosis ,Treatment Outcome ,Aortic Valve ,Heart Valve Prosthesis ,Baseline characteristics ,Angiography ,Cardiology ,Cardiology and Cardiovascular Medicine ,business - Abstract
The success rate of coronary angiography (CA) after transcatheter aortic valve implantation (TAVI) is variable. Our aim was to investigate CA difficulty, outcomes, and predictors of difficult CA after TAVI.This was an international multicentric retrospective cohort study that included patients with TAVI and subsequent CA between January 2010 and December 2019. Difficulty with CA was graded as 1 (normal), 2 (partial engagement, complete vessel opacification), 3 (partial engagement, incomplete vessel opacification), and 4 (unsuccessful angiography). Patients were grouped as (a) "easy" (grade 1 for left and right) or (b) "difficult" (grade1 for either). We compared baseline characteristics and outcomes, and performed multivariate logistic regression for predictors of difficult CA.Of 96 patients included (mean age 77.4±8.7 years, 48 [50%] male), 88 (92%) had successful CA. Right CA was successful in 80 (83%) patients and left CA in 91 (95%) (p0.0001). The "difficult" group (n=41 [43%]) had higher Society of Thoracic Surgery (STS) scores (7.6±4.9 vs 5.4±4.0; p=0.022), smaller annulus perimeters (72.4±5.4 mm vs 76.2±9.4 mm; p=0.049), greater use of self-expanding valves (83% vs 18%; p0.0001), increased valve size (26.8±2.1 mm vs 25.6±3.0 mm; p=0.032), and increased oversizing for area (44.3%±17.4% vs 23.6%±22.0%; p=0.0002) and perimeter (17.5%±8.2% vs 7.1%±10.8%; p0.0001). There was no difference in outcomes except for increased major bleeding (7.3% vs 0.0%; p=0.042). The strongest predictor for "difficult" CA was self-expanding valves when compared to balloon-expandable valves (adjusted odds ratio [aOR], 15.23; 95% confidence interval [CI], 2.27-102.40). Society of Thoracic Surgery score was borderline predictive (aOR, 1.26; 95% CI, 1.04-1.52).Our results show that after TAVI, CA success rate is high, right CA is more difficult than left, self-expanding valves predispose to difficult CA, and STS score weakly predicts difficult CA. This study is hypothesis-generating and more research is required to confirm these findings.
- Published
- 2021