Chodór Piotr, Wilczek Krzysztof, Przybylski Roman, Głowacki Jan, Kukulski Tomasz, Streb Witold, Niklewski Tomasz, Honisz Grzegorz, Trzeciak Przemysław, Podolecki Tomasz, Włoch Łukasz, Zembala Marian, Kalarus Zbigniew
Department of Cardiology, Silesian Center for Heart Diseases, Congenital Heart Diseases and Electrotherapy, Medical University of Silesia, Zabrze, Poland.
Cardiol J. 2017;24(5):467-476. doi: 10.5603/CJ.a2017.0014. Epub 2017 Feb 2.
Paravalvular leak (PVL) has significant impact on long-term outcomes in patients after transcatheter aortic valve implantation (TAVI). This study sought to determine whether multi-slice computed tomography (MSCT)-guided valve selection reduces PVL after CoreValve implantation.
The analysis encompassed 69 patients implanted with CoreValve and were divided into two groups. In Group I (30 patients), valve selection was based on standard procedures, in Group II (39 patients), on MSCT measurements. Paravalvular leak was assessed with angiography and echocardiography.
Multi-slice computed tomography results influenced a change of decision as to the size of the implanted valve in 12 (30.9%) patients in Group II and would have caused the decision to change in 9 (37.5%) patients in Group I. The degree of oversizing in Group I and II was 12.8% ± ± 7.6% vs. 18.6% ± 5.1% (p = 0.0006), respectively. The oversizing among the patients with leak degree of 0-1 and ≥ 2 was 18.1% ± 6.0% and 12.8% ± 7.4% (p = 0.0036). Angiographic assessment indicated post-procedural PVL ≥ 2 in 50% of patients in Group I and 20.5% in Group II (p = 0.01), while echocardiographic assessment indicated the same in 73.3% of patients in Group I and 45.6% in Group II (p = 0.0136). The composite endpoint occurred in 26.6% (8/30) patients in Group I vs. 5.1% (2/39) patients in Group II (p = 0.0118).
Selecting the CoreValve device based on MSCT resulted in smaller rates of PVL and less frequent composite endpoint. In 1/3 of patients MSCT led to a change of the valve size. The degree of oversizing had a significant impact on PVL.
瓣周漏（PVL）对经导管主动脉瓣植入术（TAVI）后患者的长期预后有重大影响。本研究旨在确定多层螺旋计算机断层扫描（MSCT）引导下的瓣膜选择是否能减少CoreValve植入术后的瓣周漏。
分析纳入69例植入CoreValve的患者，并将其分为两组。第一组（30例患者）根据标准程序进行瓣膜选择，第二组（39例患者）根据MSCT测量结果进行瓣膜选择。通过血管造影和超声心动图评估瓣周漏情况。
MSCT结果使第二组中12例（30.9%）患者改变了植入瓣膜尺寸的决策，而在第一组中9例（37.5%）患者本可导致决策改变。第一组和第二组的尺寸过大程度分别为12.8%±7.6%和18.6%±5.1%（p = 0.0006）。漏血程度为0 - 1级和≥2级患者的尺寸过大程度分别为18.1%±6.0%和12.8%±7.4%（p = 0.0036）。血管造影评估显示，第一组50%的患者术后瓣周漏≥2级，第二组为20.5%（p = 0.01）；而超声心动图评估显示，第一组73.3%的患者和第二组45.6%的患者出现同样情况（p = 0.0136）。第一组26.6%（8/30）的患者出现复合终点事件，第二组为5.1%（2/39）（p = 0.0118）。
基于MSCT选择CoreValve装置可降低瓣周漏发生率，并减少复合终点事件的发生频率。在三分之一的患者中，MSCT导致瓣膜尺寸改变。尺寸过大程度对瓣周漏有显著影响。
