Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA.
Catheter Cardiovasc Interv. 2021 Jan 1;97(1):E79-E87. doi: 10.1002/ccd.28890. Epub 2020 Apr 7.
We sought to determine hemodynamic effects of aortic paravalvular leak (PVL) and predictors of clinical outcomes after aortic PVL closure.
The significance of hemodynamic alterations in PVL and relation to severity, procedural success of percutaneous closure and clinical outcomes have not been defined.
Patients undergoing percutaneous PVL closure between July 21, 2004 and September 10, 2018 were included. PVL severity was assessed by echocardiography and aortic angiography. Hemodynamics were assessed by intra-arterial pressure tracings before and after PVL closure. The primary outcome was a composite of mortality, redo aortic valve replacement (AVR) and redo PVL closure.
One hundred and seventeen patients (mean age 70.3 ± 14.9 years, 79% surgical and 21% transcatheter prostheses) underwent PVL closure with 94% technical success. PVL was moderate or greater in 106 (91%) at baseline and 11 (11%) post-procedure. Diastolic BP for those with moderate or greater PVL was lower than for those with less PVL (50.3 ± 11.7 vs. 56.5 ± 12.4 mmHg, p < .001). Pulse pressure was similar between these groups (69.9 ± 20.3 vs. 67.4 ± 21.2 mmHg, p = .39). 35 patients (34%) had 40 events during a mean follow-up of 1.6 ± 1.9 years (23 deaths, 12 redo AVR, and five redo PVL closures). In a multivariate model, final diastolic BP <47 mmHg (HR 3.27 [1.45-7.36], p = .007) was a significant predictor of the composite endpoint.
Diastolic BP was significantly associated with aortic PVL severity and clinical outcomes after PVL closure. In contrast, pulse pressure did not correlate with PVL severity or outcomes. These findings have implications for clinical management of patients with aortic PVL.
我们旨在确定主动脉瓣周漏（PVL）的血液动力学影响以及主动脉瓣周漏闭合后临床结局的预测因素。
PVL 中的血液动力学改变及其与严重程度、经皮闭合术的成功率和临床结局的关系尚未确定。
纳入 2004 年 7 月 21 日至 2018 年 9 月 10 日期间接受经皮 PVL 闭合术的患者。通过超声心动图和主动脉造影评估 PVL 严重程度。通过 PVL 闭合前后的动脉压力轨迹评估血液动力学。主要结局是死亡率、再次主动脉瓣置换术（AVR）和再次 PVL 闭合的复合结局。
117 例患者（平均年龄 70.3±14.9 岁，79%为外科手术，21%为经导管假体）接受了 PVL 闭合术，技术成功率为 94%。基线时有 106 例（91%）患者的 PVL 为中度或更严重，11 例（11%）患者在术后为中度或更严重。中度或更严重 PVL 的患者舒张压低于 PVL 较轻的患者（50.3±11.7 与 56.5±12.4mmHg，p<0.001）。两组间脉压相似（69.9±20.3 与 67.4±21.2mmHg，p=0.39）。在平均 1.6±1.9 年的随访期间，35 例患者（34%）发生 40 起事件（23 例死亡，12 例再次 AVR，5 例再次 PVL 闭合）。在多变量模型中，终末期舒张压<47mmHg（HR 3.27[1.45-7.36]，p=0.007）是复合终点的显著预测因素。
舒张压与主动脉瓣周漏的严重程度及 PVL 闭合后临床结局显著相关。相比之下，脉压与 PVL 严重程度或结局无关。这些发现对主动脉瓣周漏患者的临床管理具有意义。
