俞吉维,杜润,朱政斌,张瑞岩

• 1:上海交通大学医学院附属瑞金医院心脏科

摘要(Abstract)：

接受经导管主动脉瓣置换术（TAVR）的患者常合并冠状动脉疾病（CAD），此外，TAVR术中可能存在冠状动脉闭塞的风险。随着TAVR适应证的扩展，对于TAVR患者CAD管理变得尤为重要。本文对TAVR患者合并冠状动脉病变的流行病学及预后、处理原则及策略，TAVR术中冠状动脉风险的评估及应对进行综述。

关键词(KeyWords)： 经导管主动脉瓣置换术;冠状动脉疾病;主动脉瓣狭窄

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 俞吉维,杜润,朱政斌,张瑞岩

参考文献(References)：

• [1]郭旭.经导管主动脉瓣置换术及瓣膜的发展现状[J].中国介入心脏病学杂志,2021,29(9):523-526.DOI:10.3969/j.issn.1004-8812.2021.09.009.
• [2]国医师协会心血管内科医师分会结构性心脏病专业委员会,亚太结构性心脏病青年俱乐部(大陆)编写组.结构性心脏病介入治疗2021年度报告精要[J].中国介入心脏病学杂志,2022,30(1):17-22.DOI:10.3969/j.issn.1004-8812.2022.01.003.
• [3]Mack MJ,Leon MB,Thourani VH,et al.Transcatheter aortic-valve replacement with a balloon-expandable valve in lowrisk patients[J].N Engl J Med,2019,380(18):1695-1705.DOI:10.1056/NEJMoa1814052.
• [4]Popma JJ,Deeb GM,Yakubov SJ,et al.Transcatheter aortic-valve replacement with a self-expanding valve in low-risk patients[J].N Engl J Med,2019,380(18):1706-1715.DOI:10.1056/NEJMoa1816885.
• [5]Leon MB,Smith CR,Mack MJ,et al.Transcatheter or surgical aortic-valve replacement in intermediate-risk patients[J].N Engl J Med,2016,374(17):1609-1620.DOI:10.1056/NEJMoa1514616.
• [6]Smith CR,Leon MB,Mack MJ,et al.Transcatheter versus surgical aortic-valve replacement in high-risk patients[J].N Engl J Med,2011,364(23):2187-2198.DOI:10.1056/NEJMoa1103510.
• [7]Adams DH,Popma JJ,Reardon MJ,et al.Transcatheter aortic-valve replacement with a self-expanding prosthesis[J].N Engl J Med,2014,370(19):1790-1798.DOI:10.1056/NEJMc1408396.
• [8]Ribeiro HB,Nombela-Franco L,Urena M,et al.Coronary obstruction following transcatheter aortic valve implantation:a systematic review[J].JACC Cardiovasc Interv,2013,6(5):452-461.DOI:10.1016/j.jcin.2012.11.014.
• [9] Leon MB,Smith CR,Mack M,et al.Transcatheter aorticvalve implantation for aortic stenosis in patients who cannot undergo surgery[J].N Engl J Med,2010,363(17):15 97-1607.DOI:10.1056/NEJMoa1008232.
• [10]Sankaramangalam K,Banerjee K,Kandregula K,et al.Impact of coronary artery disease on 30-day and 1-year mortality in patients undergoing transcatheter aortic valve replacement:a meta-analysis[J].J Am Heart Assoc,2017,6(10):e006092.DOI:10.1161/JAHA.117.006092.
• [11]D’ ascenzo F,Verardi R,Visconti M,et al.Independent impact of extent of coronary artery disease and percutaneous revascularisation on 30-day and one-year mortality after TAVI:a meta-analysis of adjusted observational results[J].EuroIntervention,2018,14(11):e1169-e1177.DOI:10.4244/EIJ-D-18-00098.
• [12] Minten L,Wissels P,Mccutcheon K,et al.The effect of coronary lesion complexity and preprocedural revascularization on 5-year outcomes after TAVR[J].JACC Cardiovasc Interv,2022,15(16):1611-1620.DOI:10.1016/j.jcin.2022.06.019.
• [13]Otto CM,Nishimura RA,Bonow RO,et al.2020 ACC/AHA guideline for the management of patients with valvular heart disease:executive summary:a report of the American College of Cardiology/American Heart Association Joint Committee on clinical practice guidelines[J].Circulation,2021,143(5):e35-e71.DOI:10.1161/CIR.0000000000000932.
• [14]Tarantini G,Tang G,Nai Fovino L,et al.Management of coronary artery disease in patients undergoing transcatheter aortic valve implantation.A clinical consensus statement from the European Association of Percutaneous Cardiovascular Interventions in collaboration with the ESC Working Group on Cardiovascular Surgery[J].EuroIntervention,2023,19(1):37-52.DOI:10.4244/EIJ-D-22-00958.
• [15]Ahmad Y,G?tberg M,Cook C,et al.Coronary hemodynamics in patients with severe aortic steno sis and coronary artery disease undergoing transcatheter aortic valve replacement:implications for clinical indices of coronary stenosis severity[J].JACC Cardiovasc Interv,2018,11(20):2019-2031.DOI:10.1016/j.j cin.2018.07.019.
• [16]Pesarini G,Scarsini R,Zivelonghi C,et al.Functional assessment of coronary artery disease in patients undergoing transcatheter aortic valve implantation:influence of pressure overload on the evaluation of lesions severity[J].Circ Cardiovasc Interv,2016,9(11):e004088.DOI:10.1161/CIRCINTERVENTIONS.116.004088.
• [17] Scarsini R,Pesarini G,Lunardi M,et al.Observations from a real-time,iFR-FFR"hybrid approach"in patients with severe aortic stenosis and coronary artery disease undergoing TAVI[J].Cardiovasc Revasc Med,2018,19(3 Pt B):355-359.DOI:10.1016/j.carrev.2017.09.019.
• [18]Van Den Boogert TPW,Vendrik J,Claes sen B,et al.CTCA for detection of significant coronary artery disease in routine TAVI work-up:a systematic review and meta-analysis[J].Neth Heart J,2018,26(12):591-599.DOI:10.1007/s12471-018-1149-6.
• [19]Chieffo A,Giustino G,Spagnolo P,et al.Routine screening of coronary artery disease with computed tomographic coronary angiography in place of invasive coronary angiography in patients undergoing transcatheter aortic valve replacement[J].Circ Cardiovasc Interv,2015,8(7):e002025.DOI:10.1161/CIRCINTERVENTIONS.114.002025.
• [20]Michail M,Ihdayhid AR,Comella A,et al.Feasibility and validity of computed tomography-derived fractional flow reserve in patients with severe aortic stenosis:the CAST-FFR study[J].Circ Cardiovasc Interv,2021,14(1):e009586.DOI:10.1161/CIRCINTERVENTIONS.120.009586.
• [21] Peper J,Becker LM,Van Den Berg H,et al.Diagnostic Performance of CCTA and CT-FFR for the detection of CAD in TAVR work-up[J].JACC Cardiovasc Interv,2022,15(11):1140-1149.DOI:10.1016/j.jcin.2022.03.025.
• [22]Khawaja MZ,Wang D,Pocock S,et al.The percutaneous coronary intervention prior to transcatheter aortic valve implantation(ACTIVATION)trial:study protocol for a randomized controlled trial[J].Trials,2014,15:300.DOI:10.1186/1745-6215-15-300.
• [23]Kotronias RA,Kwok CS,George S,et al.Trans catheter aortic valve implantation with or without percutaneous coronary artery revascularization strategy:a systematic review and metaanalysis[J].J Am Heart Assoc,2017,6(6):e005960.DOI:10.1161/JAHA.117.005960.
• [24]Witberg G,Regev E,Chen S,et al.The Prognostic effects of coronary disease severity and completeness of revascularization on mortality in patients undergoing transcatheter aortic valve replacement[J].JACC Cardiovasc Interv,2017,10(14):1428-1435.DOI:10.1016/j.jcin.2017.04.035.
• [25]Stefanini GG,Stortecky S,Cao D,et al.Coronary artery disease severity and aortic stenosis:clinical outcomes according to SYNTAX score in patients undergoing transcatheter aortic valve implantation[J].Eur Heart J,2014,35(37):2530-2540.DOI:10.1093/eurheartj/ehu074.
• [26]Witberg G,Zusman O,Codner P,et al.Impact of coronary artery revascularization completeness on outcomes of patients with coronary artery disease undergoing transcatheter aortic valve replacement:a meta-analysis of studies using the residual SYNTAX Score(Synergy Between PCI With Taxus and Cardiac Surgery)[J].Circ Cardiovasc Interv,2018,11(3):e006000.DOI:10.1161/CIRCINTERVENTIONS.117.006000.
• [27]Stephan T,Thoma E,Rattka M,et al.Impact of extent of coronary artery disease and percutaneous revascularization assessed by the SYNTAX score on outcomes following transcatheter aortic valve replacement[J].BMC Cardiovasc Disord,2021,21(1):568.DOI:10.1186/s12872-021-02374-y.
• [28]Ochiai T,Yoon SH,Flint N,et al.Timing and outcomes of percutaneous coronary intervention in patients whounderwent transcatheter aortic valve implantation[J].Am J Cardiol,2020,125(9):1361-1368.DOI:10.1016/j.amjcard.2020.01.043.
• [29]Van Rosendael PJ,Van Der Kley F,Kamperidis V,et al.Timing of staged percutaneous coronary intervention before transcatheter aortic valve implantation[J].Am J Cardiol,2015,115(12):1726-1732.DOI:10.1016/j.amjcard.2015.03.019.
• [30]Singh V,Rodriguez AP,Thakkar B,et al.Comparison of outcomes of transcatheter aortic valve replacement plus percutaneous coronary intervention versus transcatheter aortic valve replacement alone in the United States[J].Am J Cardiol,2016,118(11):1698-1704.DOI:10.1016/j.amjcard.2016.08.048.
• [31]Sondergaard L,Popma JJ,Reardon MJ,et al.Comparison of a complete percutaneous versus surgical approach to aortic valve replacement and revascularization in patients at intermediate surgical risk:results from the randomized SURTAVI trial[J].Circulation,2019,140(16):1296-1305.DOI:10.1161/CIRCUL ATIONAHA.118.039564.
• [32]中国医师协会心血管内科医师分会结构性心脏病专业委员会.中国经导管主动脉瓣置换术临床路径专家共识(2021版)[J].中国介入心脏病学杂志,2022,30(1):7-16.DOI:10.3969/j.issn.1004-8812.2022.01.002.
• [33]Mercanti F,Rosseel L,Neylon A,et al.Chimney stenting for coronary occlusion during TAVR:insights from the chimney registry[J].JACC Cardiovasc Interv,2020,13(6):751-761.DOI:10.1016/j.jcin.2020.01.227.
• [34]Khan JM,Greenbaum AB,Babaliaros VC,et al.BASILICA trial:one-year outcomes of transcatheter electro surgical Leaflet laceration to prevent TAVR coronary obstruction[J].Circ Cardiovasc Interv,2021,14(5):e010238.DOI:10.1161/CIRCINTERVENTIONS.120.010238.
• [35] Mentias A,Desai MY,Saad M,et al.Incidence and outcomes of acute coronary syndrome after transcatheter aortic valve replacement[J].JACC Cardiovasc Interv,2020,13(8):938-950.DOI:10.1016/j.jcin.2019.11.027.
• [36]Vilalta V,Asmarats L,Ferreira-Neto AN,et al.Incidence,clinical characteristics,and impact of acute coronary syndrome following transcatheter aortic valve replacement[J].JACC Cardiovasc Interv,2018,11(24):2523-2533.DOI:10.1016/j.jcin.2018.09.001.
• [37]Faroux L,Lhermusier T,Vincent F,et al.ST-segment elevation myocardial infarction following transcatheter aortic valve replacement[J].J Am Coll Cardiol,2021,77(17):2187-2199.DOI:10.1016/j.jacc.2021.03.014
• [38]Ochiai T,Chakravarty T,Yoon SH,et al.Coronary access after TAVR[J].JACC Cardiovasc Interv,2020,13(6):693-705.DOI:10.1016/j.jcin.2020.01.216.
• [39]Tang GHL,Zaid S,Fuchs A,et al.Alignment of transcatheter aortic-valve neo-commissures(ALIGN TAVR):impact on final valve orientation and coronary artery overlap[J].JACC Cardiovasc Interv,2020,13(9):1030-1042.DOI:10.1016/j.jcin.2020.02.005.