German Heart Centre Munich, Technical University Munich, Munich, Germany; Department of Cardiology, University Heart Centre, University Hospital Zurich, Zurich, Switzerland.
German Heart Centre Munich, Technical University Munich, Munich, Germany.
Am J Cardiol. 2021 Jan 15;139:71-78. doi: 10.1016/j.amjcard.2020.10.035. Epub 2020 Oct 24.
We aimed to evaluate the efficacy and safety of a low-dose imaging protocol to reduce intraprocedural radiation during transcatheter aortic valve implantation (TAVI). Observational analysis: 802 transfemoral TAVI patients receiving balloon-expandable devices ≥23 mm at a high-volume centre. After propensity score matching, a standard-dose group (SD, n = 333) treated between January 2014 and February 2016 was compared with a low-dose group (LD, n = 333) treated between August 2017 and March 2019 after departmental uptake of a low-dose imaging protocol (reduced field size, high table height, use of "fluoro save," 3.75 frames/second acquisition, increased filtering). Primary end point was dose-area product (DAP). Secondary safety end points were VARC-2 device success and a composite of in-hospital complications. The LD protocol was associated with lower DAP (4.64 [2.93, 8.42] vs 22.73 [12.31, 34.58] Gy⋅cm, p <0.001) and fluoroscopy time (10.4 [8.1, 13.9] vs 11.5 [9.1, 15.3] minutes, p = 0.001). Contrast use was higher in the LD group (LD 110 [94, 130] vs SD 100 [80, 135] milliliters, p = 0.042). Device success (LD 88.3% vs SD 91.3%, p = 0.25), and the composite end point (LD 8.1% vs SD 11.4%, p = 0.19) were similar. In multivariate analysis, the low-dose protocol was associated with a 19.8 Gy⋅cm reduction in procedural DAP (p <0.001). In conclusion, compared with standard imaging, a low-dose protocol for TAVI significantly reduced radiation dose without compromising outcomes.
我们旨在评估一种低剂量成像方案在经导管主动脉瓣植入术（TAVI）中减少术中辐射的疗效和安全性。观察性分析：在一家高容量中心，802 名接受球囊扩张装置≥23 毫米的经股 TAVI 患者。在倾向评分匹配后，比较了 2014 年 1 月至 2016 年 2 月接受标准剂量治疗的标准剂量组（SD，n=333）与 2017 年 8 月至 2019 年 3 月接受低剂量成像方案（减少视野大小、高手术台高度、使用“荧光节省”、3.75 帧/秒采集、增加过滤）治疗的低剂量组（LD，n=333）。主要终点是剂量面积乘积（DAP）。次要安全性终点是 VARC-2 器械成功率和住院并发症的综合指标。LD 方案与较低的 DAP（4.64[2.93，8.42]与 22.73[12.31，34.58]Gy·cm，p<0.001）和透视时间（10.4[8.1，13.9]与 11.5[9.1，15.3]分钟，p=0.001）相关。LD 组造影剂用量较高（LD 110[94，130]与 SD 100[80，135]毫升，p=0.042）。器械成功率（LD 88.3%与 SD 91.3%，p=0.25）和复合终点（LD 8.1%与 SD 11.4%，p=0.19）相似。多变量分析显示，低剂量方案与程序 DAP 降低 19.8 Gy·cm 相关（p<0.001）。总之，与标准成像相比，TAVI 的低剂量方案可显著降低辐射剂量，而不影响结果。
