经导管主动脉瓣植入术后主动脉瓣反流的决定因素。一项使用多层计算机断层扫描引导测量大小的观察性研究。

Determinants of aortic regurgitation after transcatheter aortic valve implantation. An observational study using multi-slice computed tomography-guided sizing.

作者信息

Rahhab Zouhair, El Faquir Nahid, Rodríguez-Olivares Ramón, Ren Claire, van Mieghem Nicolas, Geleijnse Marcel L, Schultz Carl, van Domburg Ron, de Jaegere Peter P

机构信息

Department of Cardiology and Radiology, Erasmus Medical Center, Rotterdam, The Netherlands.

Department of Cardiology, Royal Perth Hospital Campus, School of Medicine and Pharmacology, University of Western Australia, Perth, Australia.

出版信息

J Cardiovasc Surg (Torino). 2017 Aug;58(4):598-605. doi: 10.23736/S0021-9509.17.09391-0. Epub 2017 Jan 27.

DOI:10.23736/S0021-9509.17.09391-0

PMID:28128540

Abstract

BACKGKGROUND

The aim of this paper was to explore the determinants of aortic regurgitation (AR) after transcatheter aortic valve implantation (TAVI) using multi-slice computed tomography (MSCT) instead of echocardiography-guided sizing.

METHODS

Determinants of AR were assessed in 313 consecutive patients who underwent TAVI with the Medtronic (MCS, N.=259) or Edwards Sapien or XT (ESV, N.=54) using MSCT-guided sizing. AR was assessed by angiography immediately after TAVI (N.=313, Sellers) and by echocardiography at discharge (N.=285, VARC-2). Distinction was made between patients with grade 0-1 and grade ≥2 AR post-TAVI.

RESULTS

AR≥2 post-TAVI was seen in 91 patients or 29% (MCS 85/259: 33% vs. ESV 6/54:11%) by angiography and 94 patients or 33% (MCS 87/239:36% vs. ESV 7/46:15%) by echocardiography. By univariable analysis, patients with AR≥2 post TAVI had more AR≥2 at baseline (70% vs. 52%, P=0.003), a larger mean and maximal annulus diameter (25.0 [23.5-26.3] vs. 24.0 [22.6-26.0], P=0.025 and 27.9±2.7 mm vs. 27.0±2.8 mm, P=0.018, respectively) and a higher Agatston Score (3.9 [2.9-5.3] vs. 2.6 [1.8-3.8], P≤0.001). AR≥2 post-TAVI was more frequent after MCS than ESV (33% vs. 11%, P=0.001). There was no difference in nominal valve size relative to the patient's annulus, nor depth of implantation. By propensity score adjusted multivariable analysis, AR≥2 at baseline (odds 2.407 [95% CI: 1.472-3.938]) but above all MCS (odds: 6.047 [95% CI; 1.307- 27.976]) were independent determinants of AR≥2 post-TAVI. The latter was also confirmed by propensity score adjusted multivariable analysis in the echocardiography population (N.=285) (odds: 5.259 [95% CI; 1.070-25.851]).

CONCLUSIONS

AR≥2 is more prevalent after MCS valve implantation and is an independent determinant of AR also when using MSCT guided-sizing.

摘要

背景

本文旨在探讨使用多层螺旋计算机断层扫描（MSCT）而非超声心动图引导尺寸测量的经导管主动脉瓣植入术（TAVI）后主动脉瓣反流（AR）的决定因素。

方法

对313例连续接受TAVI的患者进行评估，这些患者使用美敦力（MCS，n = 259）或爱德华兹Sapien或XT（ESV，n = 54）瓣膜并采用MSCT引导尺寸测量。TAVI术后立即通过血管造影（n = 313，Sellers法）评估AR，并在出院时通过超声心动图（n = 285，VARC-2标准）评估AR。区分TAVI术后AR分级为0-1级和≥2级的患者。

结果

血管造影显示TAVI术后AR≥2级的患者有91例，占29%（MCS组85/259：33% vs. ESV组6/54：11%）；超声心动图显示94例，占33%（MCS组87/239：36% vs. ESV组7/46：15%）。单因素分析显示，TAVI术后AR≥2级的患者基线时AR≥2级的比例更高（70% vs. 52%，P = 0.003），平均和最大瓣环直径更大（分别为25.0 [23.5 - 26.3] vs. 24.0 [22.6 - 26.0]，P = 0.025；27.9±2.7 mm vs. 27.0±2.8 mm，P = 0.018），阿加斯顿积分更高（3.9 [2.9 - 5.3] vs. 2.6 [1.8 - 3.8]，P≤0.001）。MCS瓣膜植入后TAVI术后AR≥2级比ESV更常见（33% vs. 11%，P = 0.001）。相对于患者瓣环的标称瓣膜尺寸和植入深度无差异。通过倾向评分调整的多因素分析，基线时AR≥2级（比值比2.407 [95%可信区间：1.472 - 3.938]），但最重要的是MCS瓣膜（比值比：6.047 [95%可信区间；1.307 - 27.976]）是TAVI术后AR≥2级的独立决定因素。在超声心动图人群（n = 285）中，倾向评分调整的多因素分析也证实了这一点（比值比：5.259 [95%可信区间；1.070 - 25.851]）。