Dokument: Kurz- und Langzeitergebnisse des gecoverten Stents nach vaskulärer Leistenkomplikation bei der Transkatheter Aortenklappenimplantation
| Titel: | Kurz- und Langzeitergebnisse des gecoverten Stents nach vaskulärer Leistenkomplikation bei der Transkatheter Aortenklappenimplantation | |||||||
| Weiterer Titel: | Stent fractures after common femoral artery bail-out stenting due to suture device failure in TAVR | |||||||
| URL für Lesezeichen: | https://docserv.uni-duesseldorf.de/servlets/DocumentServlet?id=55655 | |||||||
| URN (NBN): | urn:nbn:de:hbz:061-20210316-110212-2 | |||||||
| Kollektion: | Dissertationen | |||||||
| Sprache: | Deutsch | |||||||
| Dokumententyp: | Wissenschaftliche Abschlussarbeiten » Dissertation | |||||||
| Medientyp: | Text | |||||||
| Autor: | Ledwig, Paul Maria [Autor] | |||||||
| Dateien: |
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| Beitragende: | Prof. Dr. Kelm, Malte [Betreuer/Doktorvater] Prof. Dr. Korbmacher, Bernhard [Gutachter] | |||||||
| Stichwörter: | TAVI / TAVR / Stent / gecoverter Stent / stent fracture / Stentfraktur / vaskuläre Komplikation / VASRC / Aortenklappenstenose / Aortenklappenersatz / Transkatheter Aortenklappenersatz / interventionelle Kardiologie / transfemoral | |||||||
| Dewey Dezimal-Klassifikation: | 600 Technik, Medizin, angewandte Wissenschaften » 610 Medizin und Gesundheit | |||||||
| Beschreibungen: | Kurz- und Langzeitergebnisse des gecoverten Stents nach vaskulärer Leistenkomplikation bei der Transkatheter Aortenklappenimplantation
Abstract von Paul Maria Ledwig Hintergrund Durch die weltweite Etablierung und drastische Expansion der Transkatheter Aortenklappenimplantation (TAVI) bietet sich heutzutage auch multimorbiden, inoperablen Patienten mit kalzifizierender Aortenklappenstenose (AS) die Möglichkeit eines Aortenklappenersatzes im Gegensatz zu rein konservativen Methoden. Doch trotz des technischen Fortschrittes und der steigenden Erfahrung in der Durchführung der TAVI sind vaskuläre Komplikationen in Abhängigkeit des Zugangsweges und der Zugangsart (VASRC) in diesem Zusammenhang immer noch häufig und beeinflussen das Outcome der Patienten erheblich. Patientenkollektiv und Methodik Von 389 zwischen 2013 und 2015 im Herzzentrum Düsseldorf durchgeführten transfemoralen TAVIs kam es bei 51 Patienten zu einer VASRC (13%), von denen 40 Patienten (78%) mit einem gecoverten Stent (CSG) (Fluency ®, C. R. Bard Inc., Murray Hill, NJ, 40-80 x 7-12 mm) und 11 Patienten (22%) konservativ auf andere Weise behandelt wurden. Um potentielle Stentfrakturen (StF) und deren hämodynamische Auswirkungen zu detektieren, führten wir bei 29 Patienten ein komplettes Follow-Up (FU) mit konsequenter fluoroskopischer Visualisierung sowie weiteren klinischen und funktionsdiagnostischen Untersuchungen der Stents durch. Ergebnisse Unsere Analysen konzentrierten sich dabei kurzfristig auf den sofortigen Erfolg der Blutungskontrolle und mittel- bis langfristig auf funktionelle sowie strukturelle Parameter der Stents mit einem FU von 6 bis 12 Monaten (im Mittel 334±188 Tage). In unserer Studie konnten wir zeigen, dass die Implantation eines CSG in die beschädigte Arterie zu einer sofortigen und vollständigen Blutungskontrolle führte (100%) und weder eine Nachdilatation des Stents noch eine blutkontrollierende Ballondilatation nötig waren. Wir konnten demonstrieren, dass StF in 14% (n=4) der implantierten CSG gefunden werden können und dass diese mit einer uneingeschränkten Funktionalität und ohne flusslimitierende Stenosen einhergehen. Schlussfolgerung Vor allem in Bezug auf die Indikationserweiterung des interventionellen Aortenklappenersatzes in niedrigere Risikokollektive und somit der Erwartung eines jüngeren und mobileren TAVI-Kollektivs muss geklärt werden, ob eine routinemäßige Implantation eines CSG als bail-out Prozedur bei Blutungskomplikationen über den unbestreitbaren Vorteil der unmittelbaren Blutungskontrolle hinaus zusätzliche langfristige Nachteile (z.B. Fraktur-bedingte (Re-) Stenosen / Instent-Thrombosen) mit sich bringt. Daher sollten auch zukünftig funktionelle sowie strukturelle Parameter der CSG auf Grundlage unserer Daten in prospektiven, randomisierten Studien beurteilt werden.Stent fractures after common femoral artery bail-out stenting due to suture device failure in TAVR* Abstract from Paul Maria Ledwig Background Vascular access site-related complications are frequent in the context of transfemoral transcatheter aortic valve replacement (TAVR). The implantation of a covered stent graft is an effective treatment option for bleeding control. However, the external iliac and common femoral arteries are exposed to flexion of the hip joint. Therefore, stent compression and stent/strut fractures may occur, facilitating stent occlusion. Patients and methods In all 389 patients who received transfemoral TAVR from 2013–2015 at the Duesseldorf Heart Centre, we monitored the management of vascular access site-related complications. Our analyses focused on immediate technical success and bleeding control, primary patency, and the occurrence of stent/strut fractures after six to 12 months of follow-up. Results Vascular access site-related complications occurred in 13% (n=51), whereof in 11 patients, the bleeding was successfully managed by prolonged compression or balloon catheter. In 40 out of 51 patients, a covered stent graft was implanted in the common femoral artery, leading to 100% immediate bleeding control. After a mean follow-up of 334±188 days, 28 stents out of 29 patients with completed follow-up (excluding e. g. death) were without flow-limiting stenosis (primary patency 97%) or relevant stent compression (diameter pre/ post 8.6/8.1 mm, p=0.048, late lumen loss 1.1±0.2 mm, mean flow velocity 92±34 cm/s). In four asymptomatic patients, stent/strut fractures were detected (14%) without flow-limiting stenosis. Conclusions The implantation of a covered stent graft is highly effective and safe to control vascular access site-related complications after TAVR. Stent/strut fractures in the flexible segment of the common femoral artery may occur, as consequently verified by X-ray visualization, but show no impairment on flow or clinical parameters after six to 12 months. * Veulemans V, Afzal S, Ledwig P, et al. Stent fractures after common femoral artery bail-out stenting due to suture device failure in TAVR. Vasa. 2018;47(5):393-401. doi:10.1024/0301-1526/a000712 © Hogrefe | |||||||
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Am J Med, 2020. 133(2): p. e38-e41. 117. Thyregod, H.G.H., et al., Five-Year Clinical and Echocardiographic Outcomes from the Nordic Aortic Valve Intervention (NOTION) Randomized Clinical Trial in Lower Surgical Risk Patients. Circulation, 2019. | |||||||
| Lizenz: |  Urheberrechtsschutz | |||||||
| Bezug: | 08.2015 - 02.2021 | |||||||
| Fachbereich / Einrichtung: | Medizinische Fakultät | |||||||
| Dokument erstellt am: | 16.03.2021 | |||||||
| Dateien geändert am: | 16.03.2021 | |||||||
| Promotionsantrag am: | 29.06.2020 | |||||||
| Datum der Promotion: | 16.02.2021 |
