Fink Noam, Segev Amit, Kornowski Ran, Finkelstein Ariel, Assali Abid, Rozenbaum Zach, Vaknin-Assa Hana, Halkin Amir, Fefer Paul, Ben-Shoshan Jeremy, Regev Ehud, Konigstein Maayan, Orvin Katia, Guetta Victor, Barbash Israel M
Leviev Heart Center, Interventional Cardiology, Sheba Medical Center, Ramat Gan, Israel.
Department of Cardiology, Rabin Medical Center, Petach Tikva, Israel.
Int J Cardiol. 2017 Mar 1;230:537-541. doi: 10.1016/j.ijcard.2016.12.062. Epub 2016 Dec 21.
Balloon pre-dilatation before transcatheter aortic valve replacement (TAVR) is performed at the discretion of the treating physician. Clinical data assessing the implications of this step on procedural outcomes are limited.
We conducted a retrospective analysis of 1164 consecutive TAVR patients in the Israeli multicenter TAVR registry (Sheba, Rabin, and Tel Aviv Medical Centers) between the years 2008 and 2014. Patients were divided to those who underwent balloon pre-dilation (n=1026) versus those who did not (n=138).
Rates of balloon pre-dilation decreased from 95% in 2008-2011 to 59% in 2014 (p for trend=0.002). Baseline characteristics between groups were similar except for more smoking (22% vs. 8%, p=0.008), less past CABG (18% vs. 26%, p=0.016), less diabetes mellitus (35% vs. 45%, p=0.01), and lower STS mortality scores (5.2±3.7 vs. 6.1±3.5, p=0.006) in the pre-dilatation group. The pre-dilation group included less patients with moderate to severely depressed LVEF (7% vs. 16%, p<0.001) and higher aortic peak gradients (76.9±22.7mmHg vs. 71.4±24.3mmHg, p=0.01). Stroke rates were comparable in both groups (2.5% vs. 3%, p=0.8), but pre-dilation was associated with lower rates of balloon post-dilatation (9% vs. 26%, p<0.001). On multivariate analysis, balloon pre-dilatation was not a predictor of device success or any post-procedural complications (p=0.07).
Balloon pre-dilatation was not associated with procedural adverse events and may decrease the need for balloon post-dilatation. The results of the present study support the current practice to perform liberally balloon pre-dilatation prior to valve implantation.
经导管主动脉瓣置换术（TAVR）前的球囊预扩张由治疗医师自行决定。评估这一步骤对手术结果影响的临床数据有限。
我们对2008年至2014年间以色列多中心TAVR注册研究（Sheba、Rabin和特拉维夫医疗中心）中连续的1164例TAVR患者进行了回顾性分析。患者分为接受球囊预扩张的患者（n = 1026）和未接受球囊预扩张的患者（n = 138）。
球囊预扩张率从2008 - 2011年的95%降至2014年的59%（趋势p值 = 0.002）。两组间的基线特征相似，但预扩张组吸烟更多（22%对8%，p = 0.008），既往冠状动脉旁路移植术（CABG）史更少（18%对26%，p = 0.016），糖尿病更少（35%对45%，p = 0.01），以及胸外科医师协会（STS）死亡率评分更低（5.2±3.7对6.1±3.5，p = 0.006）。预扩张组中度至重度左心室射血分数（LVEF）降低的患者更少（7%对16%，p < 0.001），主动脉峰值梯度更高（76.9±22.7mmHg对71.4±24.3mmHg，p = 0.01）。两组的卒中发生率相当（2.5%对3%，p = 0.8），但预扩张与球囊后扩张率较低相关（9%对26%，p < 0.001）。多因素分析显示，球囊预扩张不是器械成功或任何术后并发症的预测因素（p = 0.07）。
球囊预扩张与手术不良事件无关，且可能减少球囊后扩张的需求。本研究结果支持目前在瓣膜植入前自由进行球囊预扩张的做法。
