Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio; Imaging Institute, Cleveland Clinic, Cleveland, Ohio.
J Thorac Cardiovasc Surg. 2014 Jun;147(6):1847-54. doi: 10.1016/j.jtcvs.2013.05.047. Epub 2013 Jul 16.
Patients undergoing transcatheter aortic valve replacement (TAVR), as compared with those undergoing surgical aortic valve replacement (AVR), have higher postprocedural aortic regurgitation (AR), associated with higher mortality. We hypothesized that reduced annular deformation is associated with higher postprocedural AR and sought to assess incremental value of assessment of aortic annular deformation in prediction of post-TAVR AR.
We included 87 patients with high-risk severe aortic stenosis (AS) (81 ± 10 years, 54% men) who underwent preprocedural echocardiography and contrast-enhanced (4-dimensional) multidetector computed tomography (MDCT) of the aortic root, followed by TAVR (n = 55) or surgical AVR (n = 32). On MDCT, minimal/maximal annular circumference, circumferential deformation (maximum-minimum over cardiac cycle), and eccentricity (largest/smallest diameter during systole) were calculated. Degree of commissural/annular calcification was graded semiquantitatively (scale 1-3). Oversizing/undersizing of the prosthesis during TAVR was assessed.
Pre-AVR aortic valve area (0.6 ± 0.1 vs 0.6 ± 0.1 cm(2)), mean aortic valve gradient (46 ± 14 vs 45 ± 11 mm Hg), AR (1 ± 0.8 vs 0.9 ± 0.7), maximal annular circumference (8 ± 1 vs 7.9 ± 0.8 cm), annular deformation (0.3 ± 0.1 vs 0.3 ± 0.1 cm), eccentricity (1.2 ± 0.1 vs 1.2 ± 0.1), commissural (2.1 ± 0.6 vs 2 ± 0.7), and annular calcification scores (1.7 ± 0.8 vs 1.7 ± 0.8) were similar in TAVR and surgical AVR groups (P = not significant). A higher proportion of patients had ≥ mild AR in the TAVR than in the surgical AVR group (58% vs 34%; P < .03). In TAVR patients, reduced annular deformation (P = .01) predicted postprocedural AR, in addition to prosthesis undersizing (P = .03) and higher annular calcification (P = .03).
Residual post-TAVR AR is predicted by reduced aortic annular deformity, higher annular calcification, and prosthesis undersizing. Pre-TAVR 4-dimensional annular assessment aids in prediction of post-TAVR AR.
与接受外科主动脉瓣置换术（AVR）的患者相比，接受经导管主动脉瓣置换术（TAVR）的患者术后主动脉瓣反流（AR）更高，死亡率也更高。我们假设，瓣环变形减少与术后 AR 较高有关，并试图评估评估主动脉瓣环变形在预测 TAVR 后 AR 方面的增量价值。
我们纳入了 87 名患有高危重度主动脉瓣狭窄（AS）的患者（81 ± 10 岁，54%为男性），他们接受了术前超声心动图和主动脉根部增强（4 维）多层螺旋 CT（MDCT）检查，随后接受了 TAVR（n = 55）或外科 AVR（n = 32）。在 MDCT 上，计算最小/最大瓣环周长、周向变形（心动周期内的最大值-最小值）和偏心度（收缩期最大/最小直径）。瓣环/瓣环钙化程度进行半定量分级（1-3 级）。TAVR 期间评估假体的过大/过小。
术前主动脉瓣面积（0.6 ± 0.1 比 0.6 ± 0.1 cm²）、平均主动脉瓣梯度（46 ± 14 比 45 ± 11 mmHg）、AR（1 ± 0.8 比 0.9 ± 0.7）、最大瓣环周长（8 ± 1 比 7.9 ± 0.8 cm）、瓣环变形（0.3 ± 0.1 比 0.3 ± 0.1 cm）、偏心度（1.2 ± 0.1 比 1.2 ± 0.1）、瓣环交界（2.1 ± 0.6 比 2 ± 0.7）和瓣环钙化评分（1.7 ± 0.8 比 1.7 ± 0.8）在 TAVR 和外科 AVR 组之间相似（P = 无统计学意义）。TAVR 组中≥轻度 AR 的患者比例高于外科 AVR 组（58%比 34%；P <.03）。在 TAVR 患者中，瓣环变形减少（P =.01），除了假体过小（P =.03）和瓣环钙化较高（P =.03）外，还预测了术后 AR。
TAVR 后残余 AR 由主动脉瓣环变形减少、瓣环钙化增加和假体过小预测。TAVR 前 4 维瓣环评估有助于预测 TAVR 后 AR。
