经导管心脏瓣膜类型对早期亚临床瓣叶血栓形成发生率的影响。

Impact of the type of transcatheter heart valve on the incidence of early subclinical leaflet thrombosis.

机构信息

Department of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany.

Department of Radiology, Section of Cardiovascular Radiology, University of Freiburg, Freiburg im Breisgau, Germany.

出版信息

Eur J Cardiothorac Surg. 2018 Apr 1;53(4):778-783. doi: 10.1093/ejcts/ezx459.

DOI:10.1093/ejcts/ezx459

PMID:29309547

Abstract

OBJECTIVES

The aim of this study was to investigate whether balloon-expandable and self-expandable transcatheter heart valves (THVs) differ in terms of the incidence of early subclinical leaflet thrombosis (LT).

METHODS

Electrocardiographic-gated cardiac dual-source computed tomography angiography was performed at a median of 5 days after transcatheter aortic valve implantation and assessed for evidence of LT.

RESULTS

Of the 629 consecutive patients, 538 (86%) received a balloon-expandable THV and 91 (14%) a self-expandable THV. LT was documented in 77 (14%) patients with a balloon-expandable valve and in 16 (18%) with a self-expandable valve (P = 0.42). Similarly, LT was not significantly related to THV size (P = 0.62). Corresponding to a lower rate of atrial fibrillation in the group with LT [25 (27%) vs 222 (41%), P = 0.01], anticoagulation at the time of computed tomography angiography was less frequent in this group [21 (23%) vs 183 (34%), P = 0.03]. Among the other potentially relevant covariables, there was no significant difference in the clinical baseline and the procedural characteristics between patients with and without LT (age 82 ± 6 years vs 82 ± 6 years, P = 0.51; ejection fraction 49 ± 10% vs 50 ± 10%, P = 0.47). In multivariate logistic regression analysis, including potentially relevant covariables, valve type was not significantly associated with LT (P = 0.36). In the univariate and multivariate analyses, only the lack of anticoagulation at the time of computed tomography angiography was predictive of thrombus formation [0.563 (0.335-0.944), P = 0.03; 0.576 (0.343-0.970), P = 0.04].

CONCLUSIONS

In this large retrospective study of 629 patients, the type and the size of THV was not predictive of early LT.

摘要

目的

本研究旨在探讨球囊扩张式和自膨式经导管心脏瓣膜（THV）在早期亚临床瓣叶血栓形成（LT）发生率方面是否存在差异。

方法

在经导管主动脉瓣植入术后中位数 5 天进行心电图门控心脏双源 CT 血管造影，并评估 LT 的证据。

结果

在 629 例连续患者中，538 例（86%）接受了球囊扩张式 THV，91 例（14%）接受了自膨式 THV。77 例（14%）接受球囊扩张式瓣膜的患者和 16 例（18%）接受自膨式瓣膜的患者记录到 LT（P=0.42）。同样，LT 与 THV 大小无显著相关性（P=0.62）。与 LT 组较低的心房颤动发生率相对应[25（27%）比 222（41%），P=0.01]，LT 组 CT 血管造影时抗凝治疗的频率也较低[21（23%）比 183（34%），P=0.03]。在其他潜在相关协变量中，LT 患者和无 LT 患者的临床基线和手术特征之间没有显著差异（年龄 82±6 岁比 82±6 岁，P=0.51；射血分数 49±10%比 50±10%，P=0.47）。在包括潜在相关协变量的多变量逻辑回归分析中，瓣膜类型与 LT 无显著相关性（P=0.36）。在单变量和多变量分析中，仅 CT 血管造影时缺乏抗凝治疗是血栓形成的预测因素[0.563（0.335-0.944），P=0.03；0.576（0.343-0.970），P=0.04]。