Department of Cardiology, West German Heart Center Essen, Essen University Hospital, University Duisburg-Essen, Essen, Germany.
JACC Cardiovasc Interv. 2013 Sep;6(9):965-71. doi: 10.1016/j.jcin.2013.05.006.
This study sought to evaluate whether supra-aortic angiography during preparatory balloon aortic valvuloplasty (BAV) improves valve sizing.
Current recommendations for valve size selection are based on annular measurements by transesophageal echocardiography and computed tomography, but paravalvular aortic regurgitation (PAR) is a frequent problem.
Data of 270 consecutive patients with either conventional sizing (group 1, n = 167) or balloon aortic valvuloplasty-based sizing (group 2, n = 103) were compared. PAR was graded angiographically and quantitatively using several hemodynamic indices.
PAR was observed in 113 patients of group 1 and 41 patients of group 2 (67.7% vs. 39.8%, p < 0.001). More than mild PAR was found in 24 (14.4%) patients of group 1 and 8 (7.8%) patients of group 2. According to pre-interventional imaging, 40 (39%) patients had a borderline annulus size, raising uncertainty regarding valve size selection. Balloon sizing resulted in selection of the bigger prosthesis in 30 (29%) and the smaller prosthesis in the remaining patients, and only 1 of these 40 patients had more than mild PAR. As predicted by the hemodynamic indices of PAR, mortality at 30 days and 1 year was less in group 2 than in group 1 (5.8% vs. 9%, p = 0.2 and 10.6% vs. 20%, p = 0.01).
Preparatory balloon aortic valvuloplasty during transcatheter aortic valve implantation improves valve size selection, reduces the associated PAR, and increases survival in borderline cases.
本研究旨在评估在准备球囊主动脉瓣成形术（BAV）期间进行主动脉造影是否能改善瓣膜尺寸。
目前瓣膜尺寸选择的建议是基于经食管超声心动图和计算机断层扫描的环形测量，但瓣周主动脉反流（PAR）是一个常见的问题。
比较了 270 例连续患者的数据，其中包括常规尺寸（第 1 组，n=167）或基于球囊主动脉瓣成形术的尺寸（第 2 组，n=103）。使用几种血流动力学指标对 PAR 进行了影像学和定量评估。
第 1 组中有 113 例患者出现 PAR，第 2 组中有 41 例患者出现 PAR（67.7%比 39.8%，p<0.001）。第 1 组中有 24 例（14.4%）患者出现中度以上的 PAR，第 2 组中有 8 例（7.8%）患者出现中度以上的 PAR。根据术前影像学检查，40 例（39%）患者的瓣环尺寸接近临界值，这使得瓣膜尺寸的选择存在不确定性。球囊尺寸选择导致 30 例患者选择了较大的假体，其余患者选择了较小的假体，这 40 例患者中只有 1 例出现中度以上的 PAR。根据 PAR 的血流动力学指标预测，第 2 组 30 天和 1 年的死亡率低于第 1 组（5.8%比 9%，p=0.2；10.6%比 20%，p=0.01）。
经导管主动脉瓣植入术期间进行准备性球囊主动脉瓣成形术可改善瓣膜尺寸选择，减少相关的 PAR，并增加临界病例的生存率。
