Abstract
IntroductionData 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.MethodsWe 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.Results22.7% 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.ConclusionsPatients 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.
Highlights
Data regarding the prevalence of mesenteric artery stenosis in patients undergoing transcatheter aortic valve implantation (TAVI) are scarce
There is consensus that revascularization is not needed in patients with asymptomatic single-vessel stenosis, a decision not to intervene is less clear in those presenting with asymptomatic stenosis of 2 or more mesenteric arteries, as these patients may be at high risk for developing acute mesenteric ischemia (AMesI) [3]
Prognosis after TAVI of patients having Mesenteric artery stenosis (MAS) at baseline has never been studied. We performed this single-center study using prospectively collected clinical and imaging data in patients undergoing TAVI to: [1] describe the prevalence and characteristics of asymptomatic MAS, [2] compare patients at high-risk for AMesI, vs. those not at high-risk, with regard to baseline clinical and echocardiographic characteristics, [3] compare the same patients with regard to 30-day all-cause mortality, mortality related to mesenteric ischemia, and incidence of AMesI
Summary
Data regarding the prevalence of mesenteric artery stenosis in patients undergoing transcatheter aortic valve implantation (TAVI) are scarce. There is consensus that revascularization is not needed in patients with asymptomatic single-vessel stenosis, a decision not to intervene is less clear in those presenting with asymptomatic stenosis of 2 or more mesenteric arteries, as these patients may be at high risk for developing acute mesenteric ischemia (AMesI) [3]. This is all the more important as the prevalence of asymptomatic MAS increases with age, being reported as 3% in patients under 65 years and up to 18% in those older than 65 years [4]. We performed this single-center study using prospectively collected clinical and imaging data in patients undergoing TAVI to: [1] describe the prevalence and characteristics of asymptomatic MAS, [2] compare patients at high-risk for AMesI, vs. those not at high-risk, with regard to baseline clinical and echocardiographic characteristics, [3] compare the same patients with regard to 30-day all-cause mortality, mortality related to mesenteric ischemia, and incidence of AMesI
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