Department of Cardiology, University Medical Center, Utrecht, The Netherlands.
J Thorac Cardiovasc Surg. 2013 Feb;145(2):398-405. doi: 10.1016/j.jtcvs.2011.12.067. Epub 2012 Feb 27.
Moderate to severe aortic regurgitation is occurring in 20% to 30% of cases after transcatheter aortic valve implantation.
The purpose of the study was to investigate the impact of a prospective policy of "oversizing" the Edwards SAPIEN bioprosthesis (Edwards Lifesciences LLC, Irvine, Calif) relative to the diameter of the aortic annulus on the rate and severity of aortic regurgitation in 28 consecutive patients initially considered eligible for transcatheter aortic valve implantation on the basis of angiography, multislice computed tomography, and transthoracic echocardiography. This policy included the systematic use of transesophageal echocardiography to exclude borderline patients and the modification of the procedure to use the larger device possible. The results were studied on an individual patient basis.
Because 6 of 28 patients (21%) had an annulus diameter greater than 24 mm by transesophageal echocardiography, 22 patients underwent implantation of the Edwards SAPIEN prosthesis. In 6 of 22 patients, the procedure was adapted to follow our "oversizing" policy. As a result, the "prosthesis/annulus cover index" was 12.4% ± 4.3%. The procedure was successful in 21 of 22 patients (95%), and 18 patients were available for echocardiography at 1 month. Although a moderate to severe aortic regurgitation was observed pretreatment in 4 of 18 patients (22%), it was no longer the case at 1 month (0/18, 0%; P = .03). The improvement was secondary to a disappearance of the aortic regurgitation in all 7 patients with a significant aortic regurgitation at pretreatment, whereas the new aortic regurgitations appearing in 5 of the 11 patients with no aortic regurgitation at pretreatment were only mild aortic regurgitations.
In patients with a successful implantation of an Edwards SAPIEN valve, a simple "oversizing" policy based on a systematic use of transesophageal echocardiography and modification of the procedure may prevent the occurrence of moderate and severe aortic regurgitations.
经导管主动脉瓣植入术后，约 20%至 30%的病例会出现中重度主动脉瓣反流。
本研究旨在探讨相对于主动脉瓣环直径对爱德华兹 SAPIEN 生物瓣（爱德华兹生命科学公司，加利福尼亚州欧文）进行前瞻性“过大”（oversizing）处理的策略对 28 例连续患者的主动脉瓣反流发生率和严重程度的影响。这些患者最初基于血管造影、多层螺旋 CT 和经胸超声心动图被认为适合经导管主动脉瓣植入。该策略包括系统地使用经食管超声心动图排除临界患者，并修改手术以使用尽可能大的器械。研究结果基于每位患者进行评估。
由于 28 例患者中有 6 例（21%）经食管超声心动图测量的瓣环直径大于 24mm，因此 22 例患者接受了爱德华兹 SAPIEN 瓣膜植入术。在 22 例患者中，有 6 例根据我们的“过大”处理策略进行了手术调整。结果，“瓣膜/瓣环覆盖指数”为 12.4%±4.3%。22 例患者中有 21 例（95%）手术成功，18 例患者在 1 个月时可进行超声心动图检查。尽管 18 例患者中有 4 例（22%）在术前存在中重度主动脉瓣反流，但在 1 个月时已不再存在（0/18，0%；P=0.03）。这种改善是由于术前存在明显主动脉瓣反流的 7 例患者中主动脉瓣反流完全消失，而术前无主动脉瓣反流的 11 例患者中新出现的 5 例仅为轻度主动脉瓣反流所致。
对于爱德华兹 SAPIEN 瓣膜植入成功的患者，基于系统使用经食管超声心动图和修改手术的简单“过大”处理策略可能预防中重度主动脉瓣反流的发生。
