Patsalis Polykarpos C, Kloppe Axel, Plicht Björn, Schöne Dominik, Schiedat Fabian, Aweimer Assem, Kara Kaffer, Haldenwang Peter Lukas, Strauch Justus Thomas, Buck Thomas, Mügge Andreas
Department of Cardiology and Angiology, University Hospital Bergmannsheil, Ruhr University Bochum, Germany.
Department of Cardiology, Klinikum Westfalen, Heart Center Westfalen, Dortmund, Germany.
Int J Cardiol Heart Vasc. 2020 Jul 30;30:100593. doi: 10.1016/j.ijcha.2020.100593. eCollection 2020 Oct.
Current recommendations for valve size selection are based on multidimensional annular measurements, yet the overlap between two different transcatheter heart valve (THV) sizes remains. We sought to evaluate whether undersizing but overfilling eliminates the gray zones of valve sizing.
Data of 246 consecutive patients undergoing transcatheter aortic valve replacement (TAVR) with the balloon-expandable bioprosthesis with either conventional sizing and nominal filling (group 1 (NF-TAVR), n = 154) or undersizing but overfilling under a Less Is More (LIM)-Principle (group 2 (LIM-TAVR), n = 92) were compared. Paravalvular leakage (PVL) was graded angiographically and quantitatively using invasive hemodynamics.
Annulus rupture (AR) occurred only in group 1 (n = 3). Due to AR adequate evaluation of PVL was possible in 152 patients of group 1. More than mild PVL was found in 13 (8.6%) patients of group 1 and 1 (1.1%) patient of group 2 (p = 0.019). Postdilatation was performed in 31 (20.1%) patients of group 1 and 6 patients (6.5%) of group 2 (p = 0.003). For patients with borderline annulus size in group 1 (n = 35, 22.7%) valve size selection was left to the physiciańs choice resulting in selection of the larger prosthesis in 10 (28.6%). In group 2 all patients with borderline annulus (n = 36, 39.1%) received the smaller prosthesis (LIM-TAVR). The postprocedural mean transvalvular pressure gradient was significantly higher in the NF-TAVR-group (11.7 ± 4 vs. 10.1 ± 3.6 mmHg, p = 0.005).
LIM-TAVR eliminates the gray zones of sizing and associated PVL, can improve THV-performance, reduce incidence of annular rupture and simplify the procedure especially in borderline cases.
目前关于瓣膜尺寸选择的建议基于多维度瓣环测量，但两种不同经导管心脏瓣膜（THV）尺寸之间仍存在重叠。我们试图评估瓣膜尺寸过小但充盈过度是否能消除瓣膜尺寸选择的灰色地带。
比较了246例连续接受经导管主动脉瓣置换术（TAVR）患者的数据，这些患者使用球囊扩张生物假体，其中一组采用传统尺寸和标称充盈量（第1组（NF-TAVR），n = 154），另一组根据“少即是多”（LIM）原则采用尺寸过小但充盈过度的方法（第2组（LIM-TAVR），n = 92）。通过血管造影和有创血流动力学对瓣周漏（PVL）进行分级和定量评估。
瓣环破裂（AR）仅发生在第1组（n = 3）。由于AR，第1组152例患者得以对PVL进行充分评估。第1组13例（8.6%）患者和第2组1例（1.1%）患者发现有超过轻度的PVL（p = 0.019）。第1组31例（20.1%）患者和第2组6例（6.5%）患者进行了后扩张（p = 0.003）。对于第1组中瓣环尺寸临界的患者（n = 35，22.7%），瓣膜尺寸选择由医生决定，其中10例（28.6%）选择了较大的假体。在第2组中，所有瓣环尺寸临界的患者（n = 36，39.1%）均接受了较小的假体（LIM-TAVR）。NF-TAVR组术后平均跨瓣压差显著更高（11.7 ± 4 vs. 10.1 ± 3.6 mmHg，p = 0.005）。
LIM-TAVR消除了尺寸选择的灰色地带及相关的PVL，可改善THV性能，降低瓣环破裂发生率，并简化手术过程，尤其是在临界病例中。
