Department of Cardiology, Munich University Clinic, Ludwig-Maximilians University, Germany; Munich Heart Alliance at DZHK, Munich, Germany.
Department of Cardiology, Munich University Clinic, Ludwig-Maximilians University, Germany; Munich Heart Alliance at DZHK, Munich, Germany.
J Cardiovasc Comput Tomogr. 2020 Jan-Feb;14(1):36-41. doi: 10.1016/j.jcct.2019.07.004. Epub 2019 Jul 9.
To investigate the impact of left ventricular outflow tract (LVOT) calcification on the incidence of device failure and mortality in patients undergoing transcatheter aortic valve implantation (TAVI).
Of 690 consecutive patients undergoing transfemoral TAVI in our center from January 2013 to December 2015, 600 presented with non-severe (NSCA) and 90 (13.0%) with severe (SCA) LVOT calcification. Primary outcome of interest was device failure defined as a composite of procedural death, prosthesis dislocation, annulus rupture or significant para-valvular leakage (PVL). Secondary outcome of interest was 30-day and one-year all-cause mortality.
Mean age of the population was 80.8 ± 7.2 years, mean STS score was 5.7 ± 4.6% and 50.6% of the patients were women. Patients with SCA more frequently experienced device failure (10.0% vs. 3.8%, p = 0.009) and were at higher risk of 30 day (10.0% vs. 2.8%, p < 0.001) all cause mortality as compared to those with NSCA. Furthermore, patients with SCA were more frequently in need of post-dilation (15.6% vs. 8.5%, p = 0.032) and showed higher incidence of significant PVL (7.8% vs. 2.5%, p = 0.007). In multivariate analysis, SCA (hazard ratio 2.87; 95% CI 1.20 to 6.34) and use of balloon-expandable prosthesis (hazard ratio 0.32; 95% CI 0.15 to 0.73) were identified as independent predictors of device failure.
Presence of severe LVOT calcification in patients undergoing transfemoral TAVI is associated with a higher risk of device failure and short-term mortality.
研究经导管主动脉瓣置换术（TAVI）患者中左心室流出道（LVOT）钙化对器械故障和死亡率的影响。
2013 年 1 月至 2015 年 12 月，在我院行经股动脉 TAVI 的 690 例连续患者中，600 例为非严重（NSCA），90 例（13.0%）为严重（SCA）LVOT 钙化。主要研究终点为器械故障，定义为程序死亡、假体脱位、瓣环破裂或明显瓣周漏（PVL）的复合终点。次要研究终点为 30 天和 1 年全因死亡率。
人群平均年龄为 80.8±7.2 岁，平均 STS 评分为 5.7±4.6%，50.6%的患者为女性。SCA 患者器械故障发生率更高（10.0% vs. 3.8%，p=0.009），30 天全因死亡率更高（10.0% vs. 2.8%，p<0.001）。此外，SCA 患者更常需要后扩张（15.6% vs. 8.5%，p=0.032），且严重 PVL 发生率更高（7.8% vs. 2.5%，p=0.007）。多变量分析显示，SCA（风险比 2.87；95%CI 1.20 至 6.34）和使用球囊扩张型假体（风险比 0.32；95%CI 0.15 至 0.73）是器械故障的独立预测因素。
经股动脉 TAVI 患者严重 LVOT 钙化与器械故障和短期死亡率升高相关。
