D'Ancona G, Dißmann M, Heinze H, Zohlnhöfer-Momm D, Ince H, Kische S
Department of Cardiology, Vivantes Klinikum im Friedrichshain und Am Urban, Berlin, Germany.
Rostock University Medical Center, Rostock, Germany.
Neth Heart J. 2018 Aug;26(7-8):401-408. doi: 10.1007/s12471-018-1122-4.
To report our experience with the recently introduced 34 mm Evolut transcatheter aortic valve replacement (TAVR) prosthesis.
A larger TAVR prosthesis has become available for the treatment of aortic stenosis (AVS) in larger native aortic annuli (up to 30 mm). Outcomes with this new device are still unreported.
The first 25 transfemoral TAVRs performed by our team with the self-expandable 34 mm Evolut are presented. The majority of patients were male (84%) with a mean age of 81.3 ± 5.6 years, a median logistic euro-SCORE of 14.7 (5.4-61.0), and a computed tomography measured mean perimeter-derived aortic annulus diameter of 27.1 ± 1.4 mm (min. 25.0-max. 31.2 mm). We implanted one 34 mm Evolut in all patients. Median operative time and radiation time were 68.5 and 12.4 min respectively. To optimise final valve position and haemodynamic performance, at least one complete re-sheathing and re-positioning of the same valve was reported in 33.2%. New permanent pacemaker implantation (PPMI) was necessary in 28.5%. At Receiver Operating Characteristic (ROC) analysis, a minimal diameter of the left ventricular outflow tract <21.9 mm was a significant predictor for PPMI (specificity 82%; sensitivity 83%; p = 0.005; Area Under the Curve (AUC) = 0.9). Length of stay in hospital was 9.2 ± 5.8 days and no in-hospital death was reported. At discharge, grade 1 + para-valvular regurgitation was present in 32%, and no regurgitation in the remaining patients. Device success and early safety were 100% and 92% respectively.
TAVR with the 34 mm Evolut prosthesis has shown satisfactory acute outcomes. Although results are consistent with those observed with smaller Evolut prostheses, a trend for a higher PPMI rate has been noticed and could derive from a higher oversizing rate.
报告我们使用最近推出的34毫米Evolut经导管主动脉瓣置换术（TAVR）假体的经验。
一种更大尺寸的TAVR假体已可用于治疗更大的天然主动脉瓣环（最大达30毫米）中的主动脉瓣狭窄（AVS）。这种新装置的治疗结果仍未报道。
展示了我们团队使用自膨胀式34毫米Evolut进行的首批25例经股动脉TAVR手术。大多数患者为男性（84%），平均年龄81.3±5.6岁，逻辑欧洲心脏手术风险评估（logistic euro-SCORE）中位数为14.7（5.4 - 6 ..0），计算机断层扫描测量的平均周长衍生主动脉瓣环直径为27.1±1.4毫米（最小值25.0 - 最大值31.2毫米）。我们在所有患者中均植入了一枚34毫米的Evolut。手术时间中位数和透视时间分别为68.5分钟和12.4分钟。为优化最终瓣膜位置和血流动力学性能，33.2%的患者报告至少对同一瓣膜进行了一次完整的重新鞘管置入和重新定位。28.5%的患者需要植入新的永久性起搏器（PPMI）。在接受者操作特征（ROC）分析中，左心室流出道最小直径<21.9毫米是PPMI的显著预测因素（特异性82%；敏感性83%；p = 0.005；曲线下面积（AUC）= 0.9）。住院时间为9.2±5.8天，未报告院内死亡。出院时，32%的患者存在1+级瓣周反流，其余患者无反流。装置成功率和早期安全性分别为100%和92%。
使用34毫米Evolut假体进行TAVR已显示出令人满意的急性治疗结果。尽管结果与使用较小Evolut假体观察到的结果一致，但已注意到PPMI率有升高趋势，这可能源于更大的尺寸过大率。
