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Impact of preprocedural mesenteric artery stenosis and mesenteric ischemia in patients undergoing transcatheter aortic valve replacement.
Chen, Jui-Hsiang; Chen, Ying-Hwa; Chang, Hsiao-Huang; Leu, Hsin-Bang; Chen, I-Ming; Chen, Po-Lin; Lin, Su-Man.
Affiliation
  • Chen JH; Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan.
  • Chen YH; School of Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan; Division of Cardiology, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
  • Chang HH; Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan.
  • Leu HB; School of Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan; Division of Cardiology, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Division of Healthcare and Management, Healthcare Center, Taipei Veterans General Hospital, Taipei, Taiwan.
  • Chen IM; Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan.
  • Chen PL; Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan. Electronic address: yhchen@vghtpe.gov.tw.
  • Lin SM; Department of Anesthesiology, Taipei Veterans General Hospital, Taipei, Taiwan.
J Thorac Cardiovasc Surg ; 164(5): 1458-1471.e6, 2022 11.
Article de En | MEDLINE | ID: mdl-35469598
ABSTRACT

OBJECTIVES:

We aimed to examine the incidence, etiologies, and consequences of acute mesenteric ischemia as well as the impact of preprocedural subclinical mesenteric artery stenosis in patients undergoing transcatheter aortic valve replacement.

METHODS:

Among prospective follow-up of 269 consecutive patients undergoing transcatheter aortic valve replacement, diagnosis of acute mesenteric ischemia was confirmed by abdominal computed tomography. Cumulative hazard of 1-year all-cause and cardiovascular mortality according to the absence or presence of mesenteric artery stenosis 70% or greater from preprocedural computed tomography angiography was analyzed.

RESULTS:

Acute mesenteric ischemia was confirmed in 7 patients (2.6%) during mid-term (median, 33.3 months, interquartile range, 15.0-61.0 months) follow-up. Thrombotic occlusions of previously stenotic mesenteric arteries account for 4 cases (57.1%), and embolic acute mesenteric ischemia constitute the rest (42.9%) of the cases. The mortality rate of acute mesenteric ischemia was 100%. At 30 days, death from acute mesenteric ischemia accounts for 40% of all-cause mortality and 67% of cardiovascular death. By multivariable analysis, higher Society of Thoracic Surgeons score and mesenteric artery stenosis 70% or greater were independently associated with acute mesenteric ischemia. Thirty-two patients (11.9%) with preprocedural mesenteric artery stenosis 70% or greater had an increased risk of all-cause mortality (adjusted hazard ratio, 3.78; 95% confidence interval, 1.74-8.19; P = .001) at 1 year after transcatheter aortic valve replacement.

CONCLUSIONS:

Acute mesenteric ischemia, an important cause of 30-day mortality, should be considered in patients who become clinically unstable after transcatheter aortic valve replacement, particularly but not exclusively in those with preexisting mesenteric artery stenosis. Mesenteric artery stenosis should be routinely assessed in all patients who are indicated for transcatheter aortic valve replacement considering the dismal prognosis of acute mesenteric ischemia.
Sujet(s)
Mots clés

Texte intégral: 1 Collection: 01-internacional Base de données: MEDLINE Sujet principal: Sténose aortique / Maladie artérielle périphérique / Ischémie mésentérique / Remplacement valvulaire aortique par cathéter Type d'étude: Etiology_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limites: Humans Langue: En Journal: J Thorac Cardiovasc Surg Année: 2022 Type de document: Article Pays d'affiliation: Taïwan

Texte intégral: 1 Collection: 01-internacional Base de données: MEDLINE Sujet principal: Sténose aortique / Maladie artérielle périphérique / Ischémie mésentérique / Remplacement valvulaire aortique par cathéter Type d'étude: Etiology_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limites: Humans Langue: En Journal: J Thorac Cardiovasc Surg Année: 2022 Type de document: Article Pays d'affiliation: Taïwan