Department of Cardiothoracic Surgery and Anesthesiology, Karolinska University Hospital, Stockholm, Sweden
Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
J Am Heart Assoc. 2017 Aug 21;6(8):e005251. doi: 10.1161/JAHA.116.005251.
The prevalence of hypo-attenuated leaflet thickening (HALT) and reduced leaflet motion (RLM) is unknown in surgically implanted bioprostheses because systematic investigation of HALT and/or RLM is limited to a few catheter-based valves. The aim of this study was to investigate the prevalence of HALT and RLM by cardiac computed tomography in patients who underwent surgical aortic valve replacement and received a Perceval sutureless aortic valve bioprosthesis.
This was a single-center prospective observational study that included 47 patients (83.5% of the total number of implantations) who underwent surgical aortic valve replacement with implantation of the Perceval sutureless bioprosthesis (LivaNova PLC, London, UK) at Karolinska University Hospital in Stockholm, Sweden from 2012 to 2016 and were studied by cardiac computed tomography. Cardiac computed tomography was performed at a median of 491 days (range 36-1247 days) postoperatively. HALT was found in 18 (38%) patients and RLM in 13 (28%) patients. All patients with RLM had HALT. Among patients with HALT, 5 out of 18 patients (28%) were treated with anticoagulation (warfarin or any novel oral anticoagulant) at the time of cardiac computed tomography. Among patients with RLM, 3 out of 13 patients (23%) were treated with anticoagulation.
HALT and RLM were prevalent in the surgically implanted Perceval sutureless aortic valve bioprosthesis. Both HALT and RLM were found in patients with ongoing anticoagulation treatment. Whether these findings are associated with adverse events needs further study.
URL: http://www.clinicaltrials.gov. Unique identifier: NCT02671474.
由于系统研究 HALT 和/或 RLM 仅限于少数基于导管的瓣膜，因此在接受外科植入生物瓣的患者中，尚不清楚低衰减瓣叶增厚（HALT）和瓣叶运动减少（RLM）的发生率。本研究旨在通过心脏计算机断层扫描（CT）调查在瑞典斯德哥尔摩卡罗林斯卡大学医院接受外科主动脉瓣置换术并植入 Perceval 无缝线生物瓣的患者中 HALT 和 RLM 的发生率。
这是一项单中心前瞻性观察性研究，纳入了 2012 年至 2016 年期间在瑞典斯德哥尔摩卡罗林斯卡大学医院接受外科主动脉瓣置换术并植入 Perceval 无缝线生物瓣（LivaNova PLC，伦敦，英国）的 47 例患者（占植入总数的 83.5%），术后中位数 491 天（范围 36-1247 天）进行心脏 CT 检查。发现 18 例（38%）患者存在 HALT，13 例（28%）患者存在 RLM。所有存在 RLM 的患者均存在 HALT。在存在 HALT 的患者中，有 5 例（28%）在进行心脏 CT 时接受了抗凝治疗（华法林或任何新型口服抗凝剂）。在存在 RLM 的患者中，有 3 例（23%）接受了抗凝治疗。
在外科植入的 Perceval 无缝线主动脉瓣生物瓣中，HALT 和 RLM 很常见。在持续抗凝治疗的患者中发现了 HALT 和 RLM。这些发现是否与不良事件相关需要进一步研究。
