Columbia University Medical Center/New York-Presbyterian Hospital and the Cardiovascular Research Foundation, New York, NY 10032, USA.
Circ Cardiovasc Interv. 2013 Feb;6(1):85-91. doi: 10.1161/CIRCINTERVENTIONS.112.971614. Epub 2013 Jan 22.
Paravalvular regurgitation (PVR) is common after transcatheter aortic valve replacement (TAVR) and may be associated with adverse outcomes. Postdilatation (PD) has been proposed to treat PVR without being formally studied. We performed a study to evaluate the safety and efficacy of PD after balloon expandable TAVR.
Consecutive cases of TAVR were reviewed for clinical outcomes. Procedural transesophageal echocardiography imaging was reviewed for a subgroup of consecutive patients. PVR areas seen on a short-axis view were measured immediately after deployment, after PD, and at the completion of the study. Stent dimensions measured using angiography and the Paieon's C-THV system pre- and post-PD were compared. Between May 2007 and November 2011, 259 patients underwent TAVR at our institution. PD was performed in 106 patients (41%). These patients had larger annulus, lower cover-index; more often had transfemoral access and implantation of a 26 mm valve. There was a nonsignificant greater rate of cerebrovascular events in PD patients. There was no significant difference in major aortic injury and permanent pacemaker implantation rates between groups. TTE studies were reviewed in 58 patients (35 with PD and 23 without PD). PD patients had larger PVR areas immediately after deployment (40.3±17.1 versus 15.4±14.2 mm(2); P<0.0001). There was significant reduction in PVR area attributable to PD (21.7±9.3 mm(2); P<0.0001). Spontaneous regression of PVR was seen in both groups. PD increased stent dimensions.
This study demonstrates the efficacy of PD at reducing PVR in patients with greater than mild PVR after balloon-expandable TAVR.
经导管主动脉瓣置换术（TAVR）后常发生瓣周漏（PVR），且可能与不良结局相关。球囊扩张后扩张（PD）已被提议用于治疗 PVR，但尚未经过正式研究。我们进行了一项研究，以评估球囊扩张 TAVR 后 PD 的安全性和疗效。
对连续 TAVR 病例进行了临床结局回顾。对连续患者的亚组进行了经食管超声心动图检查。在部署后立即、PD 后和研究完成时，在短轴视图上测量 PVR 区域。使用血管造影和 Paieon 的 C-THV 系统比较 PD 前后的支架尺寸。2007 年 5 月至 2011 年 11 月，我院共 259 例患者行 TAVR。在 106 例患者（41%）中进行了 PD。这些患者瓣环较大，覆盖指数较低；经股动脉入路和植入 26mm 瓣膜的比例更高。PD 患者的脑血管事件发生率略高，但无统计学意义。两组之间主要主动脉损伤和永久性起搏器植入率无显著差异。对 58 例患者（35 例 PD，23 例非 PD）进行了 TTE 研究。PD 患者在部署后即刻的 PVR 面积较大（40.3±17.1 比 15.4±14.2mm2；P<0.0001）。PD 可显著减少 PVR 面积（21.7±9.3mm2；P<0.0001）。两组均可见 PVR 自发消退。PD 增加了支架尺寸。
本研究表明，在球囊扩张 TAVR 后存在大于轻度 PVR 的患者中，PD 可有效降低 PVR。
