Cedars-Sinai Heart Institute, Los Angeles, California, USA.
Am J Cardiol. 2011 Jun 15;107(12):1830-7. doi: 10.1016/j.amjcard.2011.02.317. Epub 2011 Apr 18.
We sought to determine the significance of incomplete stent frame expansion after transcatheter aortic valve implantation with the Medtronic-CoreValve device. Incomplete coronary stent expansion is a well-described phenomenon. Transcatheter valves are mounted on stents; however, the incidence of incomplete stent expansion after transcatheter aortic valve implantation, its sequelae and predictors are poorly elucidated. The 18Fr CoreValve revalving system was used to treat anatomically and clinically suitable patients with severe calcific aortic stenosis. The postdeployment stent dimensions were measured on fluoroscopic images at multiple levels of the stent frame. Incomplete expansion at each was defined as <100% expected and complete expansion as ≥100%. These parameters were correlated to the hemodynamic and clinical end points. A total of 50 consecutive patients underwent transcatheter aortic valve implantation with the Medtronic-CoreValve at a single center from January 2007 to December 2008. For the inflow portion, incomplete expansion was seen in 54% of patients and was unrelated to the aortic valve area, peak or mean aortic valve gradients, or measures of aortic regurgitation, although it was paradoxically associated with a lower incidence of prosthesis-patient mismatch. Incomplete expansion of the constrained portion was seen in 62% of the patients and displayed a trend toward a greater incidence of aortic regurgitation grade 2 or greater, although this was rare. Incomplete expansion of the Medtronic CoreValve stent frame is common. For the most part, valvular hemodynamic function was satisfactory, regardless of the degree of expansion of the stent frame that carries it and a strategy of reluctant postdilation in the context of incomplete stent frame expansion was supported.
我们旨在探讨经导管主动脉瓣植入术后美敦力-CoreValve 装置不完全支架扩张的意义。经皮冠状动脉支架扩张不完全是一种已被充分描述的现象。经导管瓣膜安装在支架上；然而，经导管主动脉瓣植入术后支架扩张不完全的发生率、其后果和预测因素尚未得到充分阐明。18Fr CoreValve 再扩张系统用于治疗解剖学和临床适宜的严重钙化性主动脉瓣狭窄患者。在支架框架的多个水平上，通过荧光透视图像测量支架扩张后的支架尺寸。每个支架的不完全扩张定义为<100%预期，完全扩张定义为≥100%。这些参数与血流动力学和临床终点相关。2007 年 1 月至 2008 年 12 月，在一家中心，共有 50 例连续患者接受了经导管主动脉瓣植入术。对于流入部分，54%的患者存在支架扩张不完全，与主动脉瓣面积、峰值或平均主动脉瓣梯度或主动脉瓣反流程度无关，尽管它与假体患者不匹配的发生率较低呈矛盾关系。在 62%的患者中发现约束部分的支架扩张不完全，且显示出更大的 2 级或更严重的主动脉瓣反流发生率的趋势，尽管这种情况很少见。美敦力 CoreValve 支架框架的不完全扩张很常见。在大多数情况下，瓣膜血流动力学功能是令人满意的，无论支架框架扩张的程度如何，并且支持在不完全支架框架扩张的情况下采用不情愿的后扩张策略。
