后扩张对经导管主动脉瓣植入术后瓣周漏减少及死亡率的影响。

Impact of post-dilatation on the reduction of paravalvular leak and mortality after transcatheter aortic valve implantation.

作者信息

Kleczyński Paweł, Dziewierz Artur, Daniec Marzena, Bagieński Maciej, Rzeszutko Łukasz, Sorysz Danuta, Trębacz Jarosław, Sobczyński Robert, Tomala Marek, Dudek Dariusz

机构信息

Institute of Cardiology, Jagiellonian University, Medical College, Krakow, Poland, Poland.

出版信息

Kardiol Pol. 2017;75(8):742-748. doi: 10.5603/KP.2017.0152.

DOI:10.5603/KP.2017.0152

PMID:28819953

Abstract

BACKGROUND

Post-implantation paravalvular leak (PVL) remains a significant complication of transcatheter aortic valve implantation (TAVI). More importantly, its occurrence may impact long-term mortality.

AIM

We sought to evaluate the effects of balloon post-dilatation (PD) on the reduction of PVL and mortality in patients undergoing TAVI.

METHODS

A total of 101 consecutive patients undergoing TAVI were enrolled. Angiography, echocardiography, and the aortic regurgitation index (ARI) were used to assess the severity of PVL before and after balloon PD. Patients were divided into two groups based whether or not PD after TAVI was performed. Reduction of PVL, change of ARI, and clinical outcomes were assessed.

RESULTS

Balloon post-dilatation was performed in 23 (22.8%) patients. In 95.6%, PVL reduction was successful (no or mild PVL). PD increased the ARI from 23.4% (22.4-24.0) to 27.1% (26.1-28.3); p < 0.001. Thirty-day mortality rate was 14.1% in the PD (-) group vs. 0.0% in the PD (+) group; p = 0.07. One-year mortality (21.8% vs. 4.3%, p = 0.97) and procedural stroke rate (7.7% vs. 8.7%, p = 0.99) were not different between the groups.

CONCLUSIONS

Balloon post-dilatation may be a safe and effective technique to reduce moderate to severe PVL after TAVI.

摘要

背景

植入后瓣周漏（PVL）仍然是经导管主动脉瓣植入术（TAVI）的一个重要并发症。更重要的是，其发生可能影响长期死亡率。

目的

我们试图评估球囊后扩张（PD）对接受TAVI患者降低PVL和死亡率的影响。

方法

连续纳入101例接受TAVI的患者。使用血管造影、超声心动图和主动脉反流指数（ARI）评估球囊PD前后PVL的严重程度。根据TAVI后是否进行PD将患者分为两组。评估PVL的降低、ARI的变化和临床结局。

结果

23例（22.8%）患者进行了球囊后扩张。95.6%的患者成功降低了PVL（无或轻度PVL）。PD使ARI从23.4%（22.4 - 24.0）增加到27.1%（26.1 - 28.3）；p < 0.001。PD（-）组的30天死亡率为14.1%，而PD（+）组为0.0%；p = 0.07。两组之间的一年死亡率（21.8%对4.3%，p = 0.97）和手术中风发生率（7.7%对8.7%，p = 0.99）没有差异。