Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, Université de Strasbourg, Strasbourg, France.
Department of Cardiology, Centre Hospitalier Universitaire Lille, Lille, France.
Thromb Haemost. 2018 May;118(5):893-905. doi: 10.1055/s-0038-1639352. Epub 2018 Mar 28.
Paravalvular aortic regurgitation (PVAR) remains a frequent postprocedural concern following transcatheter aortic valve replacement (TAVR). Persistence of flow turbulence results in the cleavage of high-molecular-weight von Willebrand multimers, primary haemostasis dysfunction and may favour bleedings. Recent data have emphasized the value of a point-of-care measure of von Willebrand factor-dependent platelet function (closure time [CT] adenosine diphosphate [ADP]) in the monitoring of immediate PVAR. This study examined whether CT-ADP could detect PVAR at 30 days and bleeding complications following TAVR.
CT-ADP was assessed at baseline and the day after the procedure. At 30 days, significant PVAR was defined as a circumferential extent of regurgitation more than 10% by transthoracic echocardiography. Events at follow-up were assessed according to the Valve Academic Research Consortium-2 consensus classification.
Significant PVAR was diagnosed in 44 out of 219 patients (20.1%). Important reduction of CT-ADP could be found in patients without PVAR, contrasting with the lack of CT-ADP improvement in significant PVAR patients. By multivariate analysis, CT-ADP > 180 seconds (hazard ratio [HR]: 5.1, 95% confidence interval [CI]: 2.5-10.6; < 0.001) and a self-expandable valve were the sole independent predictors of 30-day PVAR. At follow-up, postprocedural CT-ADP >180 seconds was identified as an independent predictor of major/life-threatening bleeding (HR: 1.7, 95% CI [1.0-3.1]; = 0.049). Major/life-threatening bleedings were at their highest levels in patients with postprocedural CT-ADP > 180 seconds (35.2 vs. 18.8%; = 0.013).
Postprocedural CT-ADP > 180 seconds is an independent predictor of significant PVAR 30 days after TAVR and may independently contribute to major/life-threatening bleedings.
经导管主动脉瓣置换术（TAVR）后，瓣周主动脉反流（PVAR）仍然是一个常见的术后问题。血流湍流的持续存在导致高分子量 von Willebrand 多聚体的裂解、主要止血功能障碍，并可能有利于出血。最近的数据强调了即时监测 PVAR 时 von Willebrand 因子依赖性血小板功能的即时护理测量（ADP 诱导的血小板聚集功能检测）的价值。本研究旨在探讨 TAVR 后 30 天时 ADP 诱导的 CT 能否检测到 PVAR 和出血并发症。
在基线和术后第 1 天评估 ADP 诱导的 CT。30 天时，通过经胸超声心动图诊断为反流程度超过 10%的为有意义的 PVAR。根据 Valve Academic Research Consortium-2 共识分类评估随访时的事件。
在 219 例患者中，44 例（20.1%）诊断为有意义的 PVAR。在没有 PVAR 的患者中可以发现 ADP 诱导的 CT 显著降低，而在有意义的 PVAR 患者中则没有 ADP 诱导的 CT 改善。多变量分析显示，CT-ADP>180 秒（危险比 [HR]：5.1，95%置信区间 [CI]：2.5-10.6；<0.001）和自膨式瓣膜是 30 天 PVAR 的唯一独立预测因素。在随访中，术后 CT-ADP>180 秒被确定为主要/危及生命出血的独立预测因素（HR：1.7，95%CI [1.0-3.1]；=0.049）。在术后 CT-ADP>180 秒的患者中，主要/危及生命的出血发生率最高（35.2%比 18.8%；=0.013）。
TAVR 后 30 天，术后 CT-ADP>180 秒是有意义的 PVAR 的独立预测因素，并且可能独立导致主要/危及生命的出血。
