Prevalence and Prognostic Value of Mesenteric Artery Stenosis in Patients Undergoing Transcatheter Aortic Valve Implantation

Frontiers in Cardiovascular Medicine

article

Henri Lu¹  David Rotzinger²  Pierre Monney¹  Olivier Muller¹  Michael Egea²  Matthieu Grange³  Eric Eeckhout¹  Matthias Kirsch⁴  Salah D. Qanadli² 

[1] Service of Cardiology, Lausanne University Hospital and University of Lausanne;Cardiothoracic and Vascular Unit, Department of Radiology, Lausanne University Hospital;Department of Medical Imaging, Neuchâtel Cantonal Hospital;Service of Cardiovascular Surgery, Lausanne University Hospital and University of Lausanne

关键词: transcatheter aortic valve implantation;    TAVI;    TAVR;    mesenteric artery stenosis;    acute mesenteric ischemia;   

DOI  :  10.3389/fcvm.2022.750634

学科分类：地球科学(综合)

来源: Frontiers

【 摘 要 】

Introduction Data regarding the prevalence of mesenteric artery stenosis in patients undergoing transcatheter aortic valve implantation (TAVI) are scarce. Whether patients with high-risk features for acute mesenteric ischemia (AMesI) have a worse prognosis compared with those without high-risk features is unknown. We aimed to address these questions. Methods We included 361 patients who underwent TAVI between 2015 and 2019. Using pre-TAVI computed tomography exams, the number of stenosed arteries in each patient and the degree of stenosis for the coeliac trunk (CTr), SMA and inferior mesenteric artery (IMA) were analyzed. High-risk features for AMesI were defined as the presence of ≥2 arteries presenting with ≥50% stenosis. Patient demographic and echocardiographic data were collected. Endpoints included 30-day all-cause mortality, mortality and morbidity related to mesenteric ischemia. Results 22.7% of patients had no arterial stenosis, while 59.3% had 1 or 2 stenosed arteries, and 18.0% presented stenoses in 3 arteries. Prevalence of significant stenosis (≥50%) in CTr, SMA, and IMA were respectively 11.9, 5.5, 10.8%. Twenty patients at high-risk for AMesI were identified: they had significantly higher all-cause mortality (15.0 vs. 1.2%, p < 0.001) and higher mortality related to AMesI (5.0 vs. 0.3%, p = 0.004), compared with non-high-risk patients. Conclusions Patients at high-risk for AMesI presented with significantly higher 30-day all-cause mortality and mortality related to AMesI following TAVI. Mesenteric revascularization before TAVI interventions may be beneficial in these patients. Prospective studies are needed to clarify these questions.

【 授权许可】

CC BY