Drakopoulou Maria, Toutouzas Konstantinos, Stathogiannis Konstantinos, Latsios George, Sideris Skevos, Xanthopoulou Maria, Penesopoulou Vicky, Trantalis George, Synetos Andreas, Papanikolaou Angelos, Aggeli Constantina, Vavuranakis Manolis, Tousoulis Dimitrios
Hippokration Hospital, 26 Karaoli and Dimitriou Streets, 15562 Holargos, Athens, Greece.
J Invasive Cardiol. 2019 May;31(5):E76-E82.
In transcatheter aortic valve implantation (TAVI), prosthesis over-sizing prevents paravalvular leak (PVL). Strategies of over-sizing for self-expanding bioprostheses are not well established at present.
Patients with aortic valve stenosis scheduled for TAVI underwent preprocedural multislice computed tomography. Based on the degree of over-sizing, a ROC curve was drawn to define the optimal value of valve sizing for reducing PVL after TAVI.
A total of 152 consecutive patients were included in the study (mean age, 79.95 ± 7.71 years; log EuroScore: 23.87 ± 8.93%). Based on the ROC curve, sizing of 14% was the optimal that would lead to less moderate/severe PVL (P<.01). Group 1 was defined as sizing <14% (n = 49 patients) and group 2 was defined as sizing ≥14% (n = 103 patients). During a follow-up period of 36 ± 14 months, a total of 9 patients died from group 1 vs 4 patients from group 2 (P<.01). Two of the patients who died had moderate/severe PVL and 11 had no/mild PVL (P=.27). From the population, a total of 49 patients (32%) were found to be in the "borderline" zone. Patients who received the smaller valve had lower mean left ventricular outflow tract diameter (P=.048), higher rate of calcium load (mild: 10 [32%] vs 13 [72%]; moderate: 16 [52%] vs 3 [17%]; severe: 5 [16%] vs 2 [11%]; P=.02) and lower mean of sinus of Valsalva diameter (P=.046) compared with patients who received the bigger valve.
In patients undergoing TAVI, over-sizing the prosthesis at least 14% reduces PVL. In borderline cases, taking into consideration additional anatomical parameters may result in low rates of PVL.
在经导管主动脉瓣植入术（TAVI）中，瓣膜尺寸过大可预防瓣周漏（PVL）。目前，自膨胀生物瓣膜尺寸过大的策略尚未完全确立。
计划接受TAVI的主动脉瓣狭窄患者在术前接受多层螺旋计算机断层扫描。根据尺寸过大的程度绘制ROC曲线，以确定TAVI后减少PVL的最佳瓣膜尺寸值。
本研究共纳入152例连续患者（平均年龄79.95±7.71岁；欧洲心脏手术风险评估系统log评分：23.87±8.93%）。根据ROC曲线，14%的尺寸是导致较少中度/重度PVL的最佳尺寸（P<0.01）。第1组定义为尺寸<14%（n = 49例患者），第2组定义为尺寸≥14%（n = 103例患者）。在36±14个月的随访期内，第1组共有9例患者死亡，第2组有4例患者死亡（P<0.01）。死亡的2例患者有中度/重度PVL，11例无/轻度PVL（P = 0.27）。在总体人群中，共发现49例患者（32%）处于“临界”区域。与接受较大瓣膜的患者相比，接受较小瓣膜的患者左心室流出道平均直径较低（P = 0.048），钙化负荷率较高（轻度：10例[32%]对13例[72%]；中度：16例[52%]对3例[17%]；重度：5例[16%]对2例[11%]；P = 0.02），主动脉瓣窦平均直径较低（P = 0.046）。
在接受TAVI的患者中，将瓣膜尺寸至少增大14%可减少PVL。在临界病例中，考虑额外的解剖参数可能导致较低的PVL发生率。
