经计算机断层扫描定义的瓣叶血栓形成在经导管主动脉瓣置换术的瓣环内与瓣环上的发生率。
The prevalence of computed tomography-defined leaflet thrombosis in intra- versus supra-annular transcatheter aortic valve prostheses.
机构信息
Monash Cardiovascular Research Centre, MonashHEART, Monash Health, and Monash University, Clayton, Victoria, Australia.
出版信息
Catheter Cardiovasc Interv. 2018 Dec 1;92(7):1414-1416. doi: 10.1002/ccd.27702. Epub 2018 Sep 14.
INTRODUCTION
Leaflet thrombosis (LT) defined by computed tomography (CT) following transcatheter aortic valve replacement (TAVR) has been shown to increase cerebrovascular events. The neo-sinus plays an important role in the development of LT. Intra-annular valves (IAV) have a larger neo-sinus when compared to supra-annular valves (SAV), and has been associated with larger thrombus burden. The prevalence of LT with IAV and SAV in a larger, diverse cohort is unknown.
METHODS
We performed a systematic review to assess the prevalence of LT in IAV versus SAV TAVR prostheses. Inclusion criteria were (1) reported CT-defined LT following TAVR, (2) comparison between LT and non-LT cohort, (3) separate registry/database, and (4) fully published status. A total of 2,013 citations were reviewed and 7 studies were included.
RESULTS
Overall, 1,644 patients were included from 7 observational studies and the prevalence of LT following TAVR was 12.8%. The Portico valve system (IAV) had the highest prevalence of LT with 35.2%, followed by Symetis Acurate Neo (SAV) at 15.4% and the Lotus valve system (IAV) at 14.5%. LT occurred more frequently in IAV than SAV (13.5% vs. 7%, P = 0.02). Subanalysis of IAV versus SAV with the exclusion of the Portico valve was performed to ensure results were not influenced by this valve system and revealed IAV still had higher rates of LT (12.1% vs. 7%, P = 0.05).
CONCLUSION
In summary, IAV prostheses appear to be associated with higher rates of LT when compared with SAV.
简介
经计算机断层扫描（CT）诊断的经导管主动脉瓣置换（TAVR）后瓣叶血栓（LT）已被证明会增加脑血管事件。新窦在 LT 的发展中起着重要作用。与瓣上瓣膜（SAV）相比，瓣内瓣膜（IAV）的新窦更大，并且与更大的血栓负荷相关。在更大、更多样化的队列中，IAV 和 SAV 的 LT 发生率尚不清楚。
方法
我们进行了一项系统评价，以评估 IAV 与 SAV TAVR 瓣膜假体中 LT 的发生率。纳入标准为：（1）TAVR 后 CT 定义的 LT 报告，（2）LT 与非 LT 队列的比较，（3）单独的登记/数据库，以及（4）完全发表的状态。共回顾了 2013 条引文，纳入了 7 项研究。
结果
共有 7 项观察性研究的 1644 例患者纳入研究，TAVR 后 LT 的发生率为 12.8%。Portico 瓣膜系统（IAV）的 LT 发生率最高，为 35.2%，其次是 Symetis Acurate Neo（SAV）为 15.4%，Lotus 瓣膜系统（IAV）为 14.5%。IAV 的 LT 发生率高于 SAV（13.5%比 7%，P=0.02）。为确保结果不受该瓣膜系统的影响，对 IAV 与 SAV 进行了亚组分析，排除了 Portico 瓣膜，结果显示 IAV 的 LT 发生率仍较高（12.1%比 7%，P=0.05）。
结论
总的来说，与 SAV 相比，IAV 瓣膜假体似乎与更高的 LT 发生率相关。
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