经导管主动脉瓣置换术后左心室流出道钙化对手术结果的影响。
Impact of Left Ventricular Outflow Tract Calcification on Procedural Outcomes After Transcatheter Aortic Valve Replacement.
机构信息
Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland. Electronic address: https://twitter.com/taishiokuno.
Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
出版信息
JACC Cardiovasc Interv. 2020 Aug 10;13(15):1789-1799. doi: 10.1016/j.jcin.2020.04.015.
OBJECTIVES
This study aimed to systematically assess the importance of left ventricular outflow tract (LVOT) calcification on procedural outcomes and device performances with contemporary transcatheter heart valve (THV) systems.
BACKGROUND
LVOT calcification has been associated with adverse clinical outcomes after transcatheter aortic valve replacement (TAVR). However, the available evidence is limited to observational data with modest numbers and incomplete assessment of the effect of the different THV systems.
METHODS
In a retrospective analysis of a prospective single-center registry, LVOT calcification was assessed in a semiquantitative fashion. Moderate or severe LVOT calcification was documented in the presence of 2 nodules of calcification, or 1 extending >5 mm in any direction, or covering >10 % of the perimeter of the LVOT.
RESULTS
Among 1,635 patients undergoing TAVR between 2007 and 2018, moderate or severe LVOT calcification was found in 407 (24.9%). Patients with moderate or severe LVOT calcification had significantly higher incidences of annular rupture (2.3% vs. 0.2%; p < 0.001), bailout valve-in-valve implantation (2.9% vs. 0.8%; p = 0.004), and residual aortic regurgitation (11.1% vs. 6.3%; p = 0.002). Balloon-expandable valves conferred a higher risk of annular rupture in the presence of moderate or severe LVOT calcification (4.0% vs. 0.4%; p = 0.002) as compared with the other valve designs. There was no significant interaction of valve design or generation and LVOT calcification with regard to the occurrence of bailout valve-in-valve implantation and residual aortic regurgitation.
CONCLUSIONS
Moderate or severe LVOT calcification confers increased risks of annular rupture, residual aortic regurgitation, and implantation of a second valve. The risk of residual aortic regurgitation is consistent across valve designs and generations. (SWISS TAVI Registry; NCT01368250).
目的
本研究旨在系统评估左心室流出道（LVOT）钙化对当代经导管心脏瓣膜（THV）系统的手术结果和器械性能的重要性。
背景
LVOT 钙化与经导管主动脉瓣置换术（TAVR）后的不良临床结局相关。然而，现有的证据仅限于观察性数据，数量有限，并且不完全评估不同 THV 系统的影响。
方法
在一项前瞻性单中心注册研究的回顾性分析中，以半定量方式评估 LVOT 钙化。如果存在 2 个钙化结节，或 1 个向任何方向延伸 >5 毫米，或覆盖 LVOT 周长 >10%，则记录为中度或重度 LVOT 钙化。
结果
在 2007 年至 2018 年间接受 TAVR 的 1635 例患者中，发现 407 例（24.9%）存在中度或重度 LVOT 钙化。中度或重度 LVOT 钙化患者的瓣环破裂发生率显著较高（2.3%比 0.2%；p<0.001），需要紧急植入瓣膜内瓣（2.9%比 0.8%；p=0.004），以及残余主动脉瓣反流（11.1%比 6.3%；p=0.002）发生率更高。在存在中度或重度 LVOT 钙化的情况下，球囊扩张瓣膜发生瓣环破裂的风险更高（4.0%比 0.4%；p=0.002），与其他瓣膜设计相比。在紧急植入瓣膜内瓣和残余主动脉瓣反流的发生方面，瓣膜设计或代际与 LVOT 钙化之间没有显著的相互作用。
结论
中度或重度 LVOT 钙化会增加瓣环破裂、残余主动脉瓣反流和植入第二枚瓣膜的风险。残余主动脉瓣反流的风险与瓣膜设计和代际一致。（SWISS TAVI 注册研究；NCT01368250）。
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