Abramowitz Yigal, Jilaihawi Hasan, Chakravarty Tarun, Kashif Mohammad, Matar George, Hariri Babak, Patel Jigar, Nakamura Mamoo, Cheng Wen, Makkar Raj R
Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California.
Catheter Cardiovasc Interv. 2016 May;87(6):1173-9. doi: 10.1002/ccd.26311. Epub 2015 Nov 3.
To assess the procedural and short-term clinical outcome of performing balloon-expandable TAVR in patients with extremely calcified aortic valves.
Quantity of aortic valve calcification predicts rates of paravalvular regurgitation (PVR) post transcatheter aortic valve replacement (TAVR). Nonetheless, short-term outcomes of balloon-expandable TAVR in patients with extremely high calcified aortic valves have not been previously described.
We studied patients with severe aortic stenosis that underwent balloon-expandable TAVR and had a pre-procedural non-contrast CT. Twenty patients that had aortic valve calcification score (AVCS) of more than 8,000 Agatston Units were compared to 279 patients with lower calcification scores. TAVR endpoints, device success and adverse events were considered according to the Valve Academic Research Consortium-2 definitions.
Device success was 80% in the extremely high calcification group compared to 95.3% in patients with less calcified aortic valves (P = 0.004). There was significantly more postprocedural PVR in the extreme calcification group: 50%, 35%, 10%, 5% vs. 72.4%, 25.8%, 1.8%, 0% for no/trace, mild, moderate and severe PVR, respectively (P < 0.001). There was one case of ascending aortic perforation resulting in intramural hematoma that resolved with no treatment. In-hospital mortality, new pacemaker implantation and major complications were similar between groups.
Balloon-expandable TAVR in patients with extremely calcified aortic valve is associated with lower device success and greater risk of PVR. © 2015 Wiley Periodicals, Inc.
评估在主动脉瓣严重钙化患者中进行球囊扩张式经导管主动脉瓣置换术（TAVR）的手术过程及短期临床结局。
主动脉瓣钙化程度可预测经导管主动脉瓣置换术（TAVR）后瓣周反流（PVR）的发生率。然而，此前尚未描述过在主动脉瓣严重钙化患者中进行球囊扩张式TAVR的短期结局。
我们研究了接受球囊扩张式TAVR且术前进行了非增强CT检查的重度主动脉瓣狭窄患者。将20例主动脉瓣钙化评分（AVCS）超过8000阿加斯顿单位的患者与279例钙化评分较低的患者进行比较。根据瓣膜学术研究联盟-2的定义评估TAVR终点、手术成功及不良事件。
极高钙化组的手术成功率为80%，而主动脉瓣钙化程度较低患者的手术成功率为95.3%（P = 0.004）。极高钙化组术后PVR明显更多：无/微量、轻度、中度和重度PVR分别为50%、35%、10%、5%，而在钙化程度较低患者中分别为72.4%、25.8%、1.8%、0%（P < 0.001）。有1例升主动脉穿孔导致壁内血肿，未经治疗自行消退。两组之间的住院死亡率、新起搏器植入率和主要并发症相似。
在主动脉瓣严重钙化患者中进行球囊扩张式TAVR与较低的手术成功率及更高的PVR风险相关。© 2015威利期刊公司
