球囊主动脉瓣成形术对经导管主动脉瓣植入自膨胀瓣膜的影响。

Impact of balloon aortic valvuloplasty on transcatheter aortic valve implantation with self-expandable valve.

作者信息

Vavuranakis Manolis, Lavda Maria, Vrachatis Dimitrios, Papaioannou Theodore G, Kalogeras Konstantinos, Kolokathis Angelos-Michail, Kariori Maria, Lilly Scott, Siasos Gerasimos, Oikonomou Evangelos, Toutouzas Konstantinos, Stasinopoulou Myrsini, Deliveliotis Konstantinos, Tousoulis Dimitrios

机构信息

1st Department of Cardiology, National and Kapodistrian University of Athens, Medical School, General Hospital of Athens "Hippokration", Greece; The Ohio State University, Wexner Medical Center in Columbus, Columbus, OH, USA.

1st Department of Cardiology, National and Kapodistrian University of Athens, Medical School, General Hospital of Athens "Hippokration", Greece.

出版信息

J Cardiol. 2017 Jan;69(1):245-252. doi: 10.1016/j.jjcc.2016.03.016. Epub 2016 May 10.

DOI:10.1016/j.jjcc.2016.03.016

PMID:27177535

Abstract

BACKGROUND

Balloon aortic valvuloplasty (BAV) has been used prior to valve implantation of a self-expandable valve as part of the transcatheter aortic valve implantation (TAVI) procedure. We aimed to evaluate the impact of BAV prior to TAVI.

METHODS

We retrospectively studied 203 consecutive patients who were treated either with (pre-BAV-TAVI group) or without BAV (D-TAVI group). Implantation depth (ID) was angiographically measured at non-coronary cusp (NCC) and left coronary cusp (LCC) at: the starting point (stage-1), before (stage-2), and after (stage-3) final bioprosthesis release. Paravalvular regurgitation (PVR) and 1-year clinical follow-up were recorded.

RESULTS

Overall, from stage-1 to stage-3, prosthesis migrated toward the left ventricle, in both cusps and groups. At NCC a forward migration was observed from stage-1 to stage-2 in both groups (p<0.001). In the pre-BAV-TAVI group only, at NCC, an upward migration decreased the ID from stage-2 to stage-3 (p=0.022). PVR ≥grade 2, immediately after expansion was more frequently observed in pre-BAV-TAVI group (41% vs 22%, respectively; p=0.024). However, PVR was similar at discharge. Clinical parameters were comparable between the two groups.

CONCLUSIONS

The use of BAV prior to TAVI may have an impact on device final position, but not on short- and long-term clinical outcome.

摘要

背景

球囊主动脉瓣成形术（BAV）已作为经导管主动脉瓣植入术（TAVI）的一部分，在自膨胀瓣膜植入前使用。我们旨在评估TAVI前BAV的影响。

方法

我们回顾性研究了203例连续接受BAV治疗（BAV-TAVI组）或未接受BAV治疗（直接TAVI组）的患者。在非冠状动脉瓣叶（NCC）和左冠状动脉瓣叶（LCC）处，通过血管造影测量植入深度（ID）：在最终生物假体释放的起始点（阶段1）、之前（阶段2）和之后（阶段3）。记录瓣周反流（PVR）和1年临床随访情况。

结果

总体而言，从阶段1到阶段3，两个瓣叶和两组的假体均向左心室迁移。在NCC处，两组从阶段1到阶段2均观察到向前迁移（p<0.001）。仅在BAV-TAVI组中，在NCC处，从阶段2到阶段3向上迁移使ID减小（p=0.022）。在BAV-TAVI组中，扩张后立即观察到PVR≥2级的情况更为频繁（分别为41%和22%；p=0.024）。然而，出院时PVR相似。两组的临床参数具有可比性。