Colli Andrea, Besola Laura, Salizzoni Stefano, Gregori Dario, Tarantini Giuseppe, Agrifoglio Marco, Chieffo Alaide, Regesta Tommaso, Gabbieri Davide, Saia Francesco, Tamburino Corrado, Ribichini Flavio, Valsecchi Orazio, Loi Bruno, Iadanza Alessandro, Stolcova Miroslava, Minati Alessandro, Martinelli Gianluca, Bedogni Francesco, Petronio Anna, Dallago Michele, Cappai Antioco, D'Onofrio Augusto, Gerosa Gino, Rinaldi Mauro
Department of Cardiology, Thoracic and Vascular Sciences, University of Padua, Padua, Italy.
Department of Cardiology, Thoracic and Vascular Sciences, University of Padua, Padua, Italy.
Int J Cardiol. 2017 Apr 15;233:52-60. doi: 10.1016/j.ijcard.2017.02.005. Epub 2017 Feb 4.
The aim of this study was to investigate interactions among pre-procedural aortic regurgitation (AR), post-procedural paravalvular leak (PVL) and long-term clinical outcomes.
We analyzed data prospectively collected in the Italian Transcatheter balloon-Expandable Registry (ITER) on aortic stenosis (AS) patients. The degree of pre-procedural AR and post-procedural PVL was stratified as: absent/trivial, mild, and moderate/severe. VARC definitions were applied to outcomes. Of 1708 patients, preoperatively, AR was absent/trivial in 40% of the patients, mild in 42%, and moderate in 18%. Postoperatively, PVL was moderate-severe in 5%, mild in 32% of patients, and absent/trivial in 63%. Clinical follow-up, median 821days (IQR 585.75), was performed in 99.7% of patients. PVL, but not preoperative AR, was a major predictor of adverse outcome (HR 1.33, CI 95% 0.9-2.05, p=0.012 for mild PVL, HR 1.36, CI 95% 0.9-2.05, p<0.001 for PVL≥moderate and OR 1.04, p=0.97 respectively). Patients with moderate-severe PVL and preoperative left ventricle (LV) dilatation (LVEDVi>75ml/m) showed better survival than those without dilatation (HR 8.63, p=0.001).
In patients with severe AS treated with balloon-expandable TAVI, the presence of PVL, but not pre-procedural AR, was a major predictor of adverse outcome. Preoperative LV dilatation seemed to offer some clinical advantages.
本研究旨在探讨术前主动脉瓣反流（AR）、术后瓣周漏（PVL）与长期临床结局之间的相互作用。
我们分析了意大利经导管球囊扩张注册研究（ITER）中前瞻性收集的主动脉瓣狭窄（AS）患者的数据。术前AR程度和术后PVL程度分层如下：无/微量、轻度、中度/重度。结局采用VARC定义。1708例患者中，术前40%的患者AR无/微量，42%为轻度，18%为中度。术后，5%的患者PVL为中重度，32%为轻度，63%无/微量。99.7%的患者进行了临床随访，中位随访时间为821天（四分位间距585.75）。PVL而非术前AR是不良结局的主要预测因素（轻度PVL的HR为1.33，95%CI为0.9 - 2.05，p = 0.012；PVL≥中度时HR为1.36，95%CI为0.9 - 2.05，p < 0.001；OR分别为1.04，p = 0.97）。中度至重度PVL且术前左心室（LV）扩张（LVEDVi>75ml/m²）的患者比未扩张的患者生存率更高（HR为8.63，p = 0.001）。
在接受球囊扩张式经导管主动脉瓣置换术（TAVI）治疗的重度AS患者中，PVL的存在而非术前AR是不良结局的主要预测因素。术前LV扩张似乎具有一些临床优势。
