Reinöhl Jochen, Psyrakis Dimitrios, Kaier Klaus, Kodirov Sodikdjon, Siepe Matthias, Gutmann Anja, von zur Mühlen Constantin, Moser Martin, Ahrens Ingo, Pache Gregor, Zirlik Andreas, Langer Mathias, Beyersdorf Friedhelm, Zehender Manfred, Bode Christoph, Blanke Philipp
Heart Center Freiburg University, Department of Cardiology and Angiology I, Freiburg, Germany.
Institute of Medical Biometry and Informatics, Medical Center, University of Freiburg, Freiburg, Germany.
Catheter Cardiovasc Interv. 2016 Mar;87(4):807-17. doi: 10.1002/ccd.26260. Epub 2015 Oct 26.
Aortic annulus rupture is a rare, but potentially fatal complication of transcatheter aortic valve replacement (TAVR), especially when it occurs by balloon-expandable devices. In order to improve the predictability of procedures and avoid ruptures we investigated whether or not the aortic root volume measures is a useful indicator of risk, and if it could be useful for the prosthesis size selection.
From a retrospective series of 172 TAVR patients, seven experienced contained aortic annulus ruptures. The receiver operating curves were used to illustrate sensitivity and specificity of the different aortic annulus size and aortic root volume measures. The annulus area oversizing of ≥20% resulted in a sensitivity of 100%, specificity of 55.76%, and positive predictive value (PPV) of 8.75%. In patients receiving 26 mm prostheses, the aortic root volume (ARV <13600 mm(3)) provided a better specificity and PPV (79.63 and 18.52%, respectively). A two-step testing procedure considering the area derived average annulus diameter (Darea <23 mm) as a first separating parameter and then the ARV (<13,600 mm(3)) as a further indicator showed the most promising results with the PPV of 31.25%. Regardless of the procedure steps no false negative results were predicted.
Our data show that the ARV provides a better predictive value for correct prosthesis sizing than established annulus measurements, especially in 'borderline' annuli. We suggest a two-step testing procedure for prostheses size selection, considering Darea and ARV to minimize the risk of annulus rupture. Prospective studies and examination of larger datasets are warranted to confirm these findings.
主动脉瓣环破裂是经导管主动脉瓣置换术（TAVR）一种罕见但可能致命的并发症，尤其是在使用球囊扩张装置时发生。为了提高手术的可预测性并避免破裂，我们研究了主动脉根部容积测量是否是一个有用的风险指标，以及它是否有助于假体尺寸的选择。
在172例TAVR患者的回顾性系列研究中，7例发生了局限性主动脉瓣环破裂。采用受试者工作特征曲线来说明不同主动脉瓣环大小和主动脉根部容积测量的敏感性和特异性。瓣环面积过大≥20%时，敏感性为100%，特异性为55.76%，阳性预测值（PPV）为8.75%。在接受26mm假体的患者中，主动脉根部容积（ARV<13600mm³）具有更好的特异性和PPV（分别为79.63%和18.52%）。一个两步测试程序，首先将面积推导的平均瓣环直径（Darea<23mm）作为一个分离参数，然后将ARV（<13600mm³）作为进一步的指标，显示出最有前景的结果，PPV为31.25%。无论手术步骤如何，均未预测到假阴性结果。
我们的数据表明，与既定的瓣环测量相比，ARV对正确的假体尺寸选择具有更好的预测价值，尤其是在“临界”瓣环中。我们建议采用一个两步测试程序来选择假体尺寸，考虑Darea和ARV以尽量降低瓣环破裂的风险。需要进行前瞻性研究和检查更大的数据集来证实这些发现。
