| Background:Coronary artery disease(CAD)in patients with aortic stenosis(AS)Surgical aortic valve replacement(SAVR)is associated with a higher risk of postoperative complications and mortality.Transcatheter aortic valve replacement(TAVR)has been developed as a new treatment option for these high-risk patients since its introduction in 2002.Although the feasibility and effectiveness of TAVR in the treatment of high-risk patients with AS has been demonstrated,the impact of coronary artery disease(CAD)on the outcome of transcatheter aortic valve replacement(TAVR)has been poorly studied.This study retrospectively analyzed whether the short-term prognosis of patients receiving coronary revascularization in TAVR was different from that of patients not receiving revascularization.Methods:The data of 67 patients with severe aortic stenosis who received TAVR in the Affiliated Hospital of Qingdao University from September 2017 to January 2020 were retrospectively analyzed.These patients underwent at least three follow-up echocardiographic examinations after surgery.All patients’baseline,clinical data,echocardiographic features,and surgical and post-surgical details were collected in a prospective TAVR database.All patients were examined by multilayer spiral CTA before surgery for the morphology of aortic valve,whether there was coronary stenosis,and the height of the distance between the left and right coronary openings and the valve annulus.And according to the examination results to improve the preoperative preparation.All clinical data of the patients during hospitalization were collected from the postoperative period until before discharge.Cardiac ultrasound and other examination results were collected by means of patient reexamination and telephone follow-up.After statistical completion,SPSS and other software were used for statistical analysis.Results:During the 1-year follow-up after TAVR,at baseline,the revascularization group presented a higher proportion of men(82.14 vs.53.85,P=0.02).The data associated with CAD were statistically different from those of the non-revascularization group,and the rest of the baseline features were similar.Left ventricular mass index(LVMI)was significantly decreased between the two groups,but there was no statistical difference(121±30.21 g/cm~2vs.120.1±29.16 g/cm~2,P=0.89).At 1 postoperative year,Relative wall thickness(RWT)improved more significantly in the revascularization group(0.44±0.08cm vs.0.47±0.07 cm,P=0.03).At 1 and 3 months follow-up,systolic maximum flow velocity decreased more significantly in the revascularization group(2.2±0.4 m/s vs.2.6±0.62 m/s,P<0.01)and(2.1±0.41 m/s vs.2.5±0.62 m/s,P<0.01),respectively.During the 1-year follow-up,the aortic cross-valve pressure difference between the two groups was statistically significant at 1 month after TAVR,with significant improvement in the revascularization group(21±7.17 mm Hg vs.28±14.64 mm Hg,P<0.01).There was no significant difference in LVEF(53.6±8.22%vs.56.6±5.59%,P=0.1).Conclusion:Aortic stenosis with coronary heart disease patients in transcatheter aortic valve replacement before to accept revascularization and did not receive two groups of revascularization,postoperative 1 year data show that two groups of postoperative LVMi in TAVR change evident in the postoperative 1 months,then left heart change speed is slowing,and LVMi changes to 1 in two groups have no statistical difference;At 1 year after surgery,the left ventricular hypertrophy changed significantly in the revascularization group,but there was no statistical difference,and there were still centripetal hypertrophy changes in the two groups.The transvalvular pressure difference and the maximum blood flow velocity of the aorta decreased significantly within 1 month.After 3 months,the rate of left ventricular reverse change slowed down in both groups. |
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