He Yu-Xin, Fan Jia-Qi, Zhu Qi-Feng, Zhou Qi-Jing, Jiang Ju-Bo, Wang Li-Han, Ng Stella, Liu Xian-Bao, Wang Jian-An
Department of Cardiology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China.
Department of Radiology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China.
World J Emerg Med. 2019;10(4):197-204. doi: 10.5847/wjem.j.1920-8642.2019.04.001.
Current data is lacking about the progression of ascending aortic dilatation after transcatheter aortic valve replacement (TAVR) in aortic stenosis (AS) patients with bicuspid aortic valve (BAV) and tricuspid aortic valve (TAV). This study aims to assess the ascending aortic dilatation rate (mm/year) after TAVR in patients with BAV versus TAV using a multidetector computed tomography (MDCT) follow-up and to determine the predictors of ascending aortic dilatation rate.
Severe AS patients undergoing TAVR from March 2013 to March 2018 at our center with MDCT follow-ups were included. BAV and TAV were identified using baseline MDCT. Baseline and follow-up MDCT images were analyzed, and the diameters of ascending aorta were measured. Study end point is ascending aortic dilatation rate (mm/year). Furthermore, factors predicting ascending aortic dilatation rate were also investigated.
Two hundred and eight patients were included, comprised of 86 BAV and 122 TAV patients. Five, 4, 3, 2, and 1-year MDCT follow-ups were achieved in 7, 9, 30, 46, and 116 patients. The ascending aortic diameter was significantly increased after TAVR in both BAV group (43.7±4.4 mm vs. 44.0±4.5 mm; P<0.001) and TAV group (39.1±4.8 mm vs. 39.7±5.1 mm; P<0.001). However, no difference of ascending aortic dilatation rate was found between BAV and TAV group (0.2±0.8 mm/year vs. 0.3±0.8 mm/year, P=0.592). Multivariate linear regression revealed paravalvular leakage (PVL) grade was independently associated with ascending aortic dilatation rate in the whole population and BAV group, but not TAV group. No aortic events occurred during follow-ups.
Ascending aortic size continues to grow after TAVR in BAV patients, but the dilatation rate is mild and comparable to that of TAV patients. PVL grade is associated with ascending aortic dilatation rate in BAV patients post-TAVR.
目前缺乏关于患有二叶式主动脉瓣（BAV）和三叶式主动脉瓣（TAV）的主动脉瓣狭窄（AS）患者经导管主动脉瓣置换术（TAVR）后升主动脉扩张进展情况的数据。本研究旨在使用多排螺旋计算机断层扫描（MDCT）随访评估BAV患者与TAV患者TAVR后的升主动脉扩张率（毫米/年），并确定升主动脉扩张率的预测因素。
纳入2013年3月至2018年3月在本中心接受TAVR并进行MDCT随访的重度AS患者。使用基线MDCT识别BAV和TAV。分析基线和随访MDCT图像，测量升主动脉直径。研究终点是升主动脉扩张率（毫米/年）。此外，还研究了预测升主动脉扩张率的因素。
共纳入208例患者，其中86例BAV患者和122例TAV患者。7例、9例、30例、46例和116例患者分别进行了5年、4年、3年、2年和1年的MDCT随访。BAV组（43.7±4.4毫米对44.0±4.5毫米；P<0.001）和TAV组（39.1±4.8毫米对39.7±5.1毫米；P<0.001）TAVR后升主动脉直径均显著增加。然而，BAV组和TAV组之间升主动脉扩张率无差异（0.2±0.8毫米/年对0.3±0.8毫米/年，P=0.592）。多变量线性回归显示，瓣周漏（PVL）分级在总体人群和BAV组中与升主动脉扩张率独立相关，但在TAV组中并非如此。随访期间未发生主动脉事件。
BAV患者TAVR后升主动脉大小持续增加，但扩张率较轻，与TAV患者相当。PVL分级与BAV患者TAVR后升主动脉扩张率相关。
