Maeno Yoshio, Abramowitz Yigal, Kazuno Yoshio, Kawamori Hiroyuki, Mangat Geeteshwar, Takahashi Nobuyuki, Chakravarty Tarun, Nakamura Mamoo, Cheng Wen, Jilaihawi Hasan, Makkar Raj R
Cedars-Sinai Heart Institute.
Int Heart J. 2017 Feb 7;58(1):56-62. doi: 10.1536/ihj.16-217. Epub 2017 Jan 17.
Severe device landing zone calcification (DLZ-CA) predicted paravalvular leak (PVL) and post-dilatation (PD) after transcatheter aortic valve implantation (TAVI). The aim of this study was to determine the influence of DLZ-CA on PVL or PD rates after SAPIEN XT (XT) versus CoreValve (CV).We analyzed patients undergoing TAVI who had severe DLZ-CA. Severe DLZ-CA defined the upper left ventricular outflow tract calcification; the cross-sectional region 2 mm inferior to the annular plane. PVL was evaluated at 30days using transthoracic echocardiography. Overall, 133 patients had XT-TAVI and the remaining 41 patients had CV-TAVI. Two patients had annulus injury in the XT group (oversizing 20.2% and 20.5% for two XT cases). PD was less frequently performed in the XT group (34.1% versus 12.8%; P = 0.002), but PVL rates were similar between both groups (42.1% versus 41.5% for the XT and CV groups, respectively; P = 0.94). Importantly, excessive oversizing or the degree of filling volume was not associated with decreased PVL after XT-TAVI (P = non-significant for all). On multivariate analysis, CV-TAVI was found to be one of the independent predictors of need for PD (Odds ratio 3.63, 95% confidence interval 1.55 to 8.53, P = 0.003).In the setting of severe DLZ-CA, XT and CV have similar rates of PVL but XT had less need for PD. Excessive oversizing with XT carries a risk of root injury which could be further increased by DLZ-CA.
严重的器械着陆区钙化（DLZ-CA）可预测经导管主动脉瓣植入术（TAVI）后的瓣周漏（PVL）和后扩张（PD）。本研究的目的是确定DLZ-CA对SAPIEN XT（XT）与CoreValve（CV）术后PVL或PD发生率的影响。我们分析了接受TAVI且存在严重DLZ-CA的患者。严重DLZ-CA定义为左心室流出道上部钙化；在瓣环平面下方2毫米处的横截面区域。使用经胸超声心动图在30天时评估PVL。总体而言，133例患者接受了XT-TAVI，其余41例患者接受了CV-TAVI。XT组有2例患者发生瓣环损伤（两例XT病例的尺寸过大分别为20.2%和20.5%）。XT组进行PD的频率较低（34.1%对12.8%；P = 0.002），但两组的PVL发生率相似（XT组和CV组分别为42.1%对41.5%；P = 0.94）。重要的是，过度尺寸过大或充盈量程度与XT-TAVI后PVL降低无关（所有P值均无统计学意义）。多变量分析显示，CV-TAVI是需要进行PD的独立预测因素之一（比值比3.63，95%置信区间1.55至8.53，P = 0.003）。在严重DLZ-CA的情况下，XT和CV的PVL发生率相似，但XT对PD的需求较少。XT过度尺寸过大会有根部损伤风险，而DLZ-CA可能会进一步增加这种风险。
