Kaneko Hidehiro, Hoelschermann Frank, Tambor Grit, Yoon Sung-Han, Neuss Michael, Butter Christian
Heart Center Brandenburg, Department of Cardiology, Medical School Brandenburg, Bernau, Germany.
Department of Cardiology, Cedars Sinai Medical Center, Los Angeles, California.
Am J Cardiol. 2017 Feb 15;119(4):618-622. doi: 10.1016/j.amjcard.2016.10.047. Epub 2016 Nov 16.
Paravalvular regurgitation (PVR) is a common and serious complication after transcatheter aortic valve implantation (TAVI). New-generation balloon-expandable SAPIEN 3 has an outer sealing skirt to minimize PVR. However, the predictors of PVR after SAPIEN 3 transcatheter heart valve (THV) implantation have not been well investigated. We sought to clarify the determinants of PVR after TAVI using SAPIEN 3 with quantitative multidetector computed tomography (MDCT) assessment. This study analyzed 281 patients with severe symptomatic aortic stenosis who underwent TAVI using SAPIEN 3. Quantitative assessment of aortic root dimensions and calcium volume for leaflet, annulus, and left ventricular outflow tract were retrospectively performed with MDCT. MDCT nominal area oversizing was calculated using the following formula: % oversizing = (THV nominal area/MDCT derived annular area - 1) × 100. Logistic regression analysis was performed to determine the predictors of PVR greater than or equal to mild. PVR greater than or equal to mild was observed in 19% (53 of 281). Quantity and asymmetry of aortic valve calcium of annulus, left ventricular outflow tract, and leaflet were associated with higher incidence of PVR greater than or equal to mild, except leaflet asymmetry. Lower percentage of THV oversizing was also associated with PVR. Multivariable logistic regression analysis showed that larger calcification volume of annulus and lower percentage of THV oversizing were independent predictors of PVR greater than or equal to mild. These results suggest that prosthesis/annulus incongruence and aortic annulus calcification predicted PVR greater than or equal to mild after TAVI using SAPIEN 3.
瓣周反流（PVR）是经导管主动脉瓣植入术（TAVI）后常见且严重的并发症。新一代球囊扩张式SAPIEN 3具有外部密封裙边，可将PVR降至最低。然而，SAPIEN 3经导管心脏瓣膜（THV）植入术后PVR的预测因素尚未得到充分研究。我们试图通过定量多排螺旋计算机断层扫描（MDCT）评估来阐明使用SAPIEN 3进行TAVI后PVR的决定因素。本研究分析了281例接受SAPIEN 3 TAVI的重度症状性主动脉瓣狭窄患者。使用MDCT对主动脉根部尺寸以及瓣叶、瓣环和左心室流出道的钙体积进行回顾性定量评估。MDCT标称面积过大率使用以下公式计算：过大率% =（THV标称面积/MDCT得出的瓣环面积 - 1）×100。进行逻辑回归分析以确定PVR大于或等于轻度的预测因素。19%（281例中的53例）观察到PVR大于或等于轻度。瓣环、左心室流出道和瓣叶的主动脉瓣钙的数量和不对称性与PVR大于或等于轻度的较高发生率相关，但瓣叶不对称除外。THV过大率较低也与PVR相关。多变量逻辑回归分析表明，瓣环较大的钙化体积和THV较低的过大率是PVR大于或等于轻度的独立预测因素。这些结果表明，使用SAPIEN 3进行TAVI后，假体/瓣环不匹配和主动脉瓣环钙化可预测PVR大于或等于轻度。
