在经导管主动脉瓣置换术之前对自膨式瓣膜进行最佳定位可减少瓣周漏。
Optimal positioning of self-expanding valves before deployment decreases paravalvular regurgitation following transcatheter aortic valve replacement.
机构信息
Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas.
Department of Cardiovascular Surgery, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas.
出版信息
Catheter Cardiovasc Interv. 2019 Jan 1;93(1):149-155. doi: 10.1002/ccd.27829. Epub 2018 Sep 14.
OBJECTIVES
To evaluate the association between measurements performed during Medtronic CoreValve (MCV) deployment and paravalvular leak (PVL).
BACKGROUND
The MCV can be recaptured and repositioned, allowing the TAVR operator to implant at a more favorable position. The association between angiographic measurements of MCV position while the valve is recapturable and PVL post deployment has not been investigated.
METHODS
493 patients undergoing TAVR with MCV (January 2011-July 2017) were included. PVL was defined as intraprocedural aortic regurgitation that was judged clinically to require balloon postdilation. Depth of the valve at the left coronary cusp (LCC) and noncoronary cusp (NCC) were measured when the valve was 80% deployed. An optimal cutoff value for the ratio LCC/NCC for PVL was identified in 40 patients. Using this cutoff value, the association between LCC/NCC and PVL was then validated in 453 patients.
RESULTS
The median LCC/NCC was 1.51 (interquartile range 1.06-1.89).The optimal cutoff value for LCC/NCC was 1.48 (93% sensitivity, 77% specificity, AUC0.85). In the validation group 112 (24.7%) patients had PVL. For LCC/NCC ≥ 1.48, the incidence of PVL was lower compared to LCC/NCC < 1.48 (9.58% vs. 41.78%, P < 0.0001). LCC/NCC of 1.48 had a sensitivity of 79.5% and specificity of 63.6% for PVL (AUC0.72). In a multivariate model, LCC/NCC < 1.48 independently predicted PVL (OR = 6.67, 95% CI 3.96-11.23, P < 0.0001).
CONCLUSION
Positioning the MCV such that the LCC/NCC is ≥1.48 may result in less PVL.
目的
评估美敦力 CoreValve（MCV）展开过程中的测量值与瓣周漏（PVL）之间的关系。
背景
MCV 可以回收并重新定位，允许 TAVR 操作者将瓣膜植入更有利的位置。但尚未研究在可回收瓣膜时对 MCV 位置的血管造影测量值与部署后 PVL 之间的关系。
方法
纳入 2011 年 1 月至 2017 年 7 月期间接受 MCV 经导管主动脉瓣置换术（TAVR）的 493 例患者。PVL 定义为术中主动脉瓣反流，经临床判断需要球囊后扩张。当瓣膜展开 80%时，测量瓣膜在左冠状动脉瓣（LCC）和无冠状动脉瓣（NCC）的深度。在 40 例患者中确定了 LCC/NCC 比值的最佳截断值用于 PVL。使用该截断值，然后在 453 例患者中验证 LCC/NCC 与 PVL 的关系。
结果
中位数 LCC/NCC 为 1.51（四分位距 1.06-1.89）。LCC/NCC 的最佳截断值为 1.48（93%的敏感性，77%的特异性，AUC0.85）。在验证组中，112 例（24.7%）患者存在 PVL。对于 LCC/NCC≥1.48，PVL 的发生率低于 LCC/NCC<1.48（9.58%比 41.78%，P<0.0001）。LCC/NCC 为 1.48 时，对 PVL 的敏感性为 79.5%，特异性为 63.6%（AUC0.72）。在多变量模型中，LCC/NCC<1.48 独立预测 PVL（OR=6.67，95%CI 3.96-11.23，P<0.0001）。
结论
将 MCV 定位至 LCC/NCC≥1.48 可能会减少 PVL。
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