Gamet Alexandre, Chatelin Adeline, Mergy Jean, Bécat Pauline, Roumegou Pierre, Christiaens Luc
Department of Cardiology, Centre Régional Cardio-Vasculaire, CHU De Poitiers, Poitiers, France.
J Cardiovasc Echogr. 2020 Apr-Jun;30(2):88-92. doi: 10.4103/jcecho.jcecho_9_20. Epub 2020 Aug 17.
The development of transcatheter aortic valve replacement (TAVR) has led to an improvement in morbidity-mortality in the treatment of severe aortic stenosis in patients at high surgical risk. However, the procedure is not free from life-threatening cardiovascular outcomes and conductive disturbances. The objective of our study was to analyze the prognostic impact of aortic valve calcium score on the occurrence of complications following the procedure.
Patients who have benefited from TAVR with the implantation of new-generation Sapien 3 and Evolut R aortic valve prostheses between January 2017 and July 2018 with the prior realization of a cardiac computed tomography with measurement of the aortic valve calcium score were retrospectively analyzed. Primary endpoint was a composite of death, stroke, and myocardial infarction within a period of 1 month after TAVR. Relation between valvular calcium and conductive disturbances was secondarily analyzed over the same period, and occurrences of high-degree atrioventricular block (paroxysmal or permanent), new-onset left bundle branch block, and the need for permanent or transient cardiac stimulation were associated with the secondary endpoint.
Overall, 144 patients were included. The aortic valve calcium score was not significantly higher in patients who reached the primary endpoint (2936 ± 1235 vs. 3051 ± 1440, = 0.93). Among the 106 patients analyzed after excluding subjects with a prior pacemaker or left bundle branch block, aortic valvular calcium score was not statistically associated with the occurrence of conduction disturbances (3210 ± 1436 vs. 2948 ± 1223, = 0.31).
Our results suggest that the measurement of aortic valve calcium score has no prognostic value regarding mortality, cardiovascular events, or conductive disturbances after TAVR using the new generation of valves.
经导管主动脉瓣置换术（TAVR）的发展已使高危手术患者严重主动脉瓣狭窄的治疗中病死亡率得到改善。然而，该手术并非没有危及生命的心血管结局和传导障碍。我们研究的目的是分析主动脉瓣钙化评分对该手术后并发症发生的预后影响。
回顾性分析2017年1月至2018年7月期间接受TAVR并植入新一代Sapien 3和Evolut R主动脉瓣假体且之前进行过心脏计算机断层扫描并测量主动脉瓣钙化评分的患者。主要终点是TAVR后1个月内死亡、中风和心肌梗死的复合终点。同期次要分析瓣膜钙化与传导障碍之间的关系，高度房室传导阻滞（阵发性或永久性）、新发左束支传导阻滞的发生以及永久性或临时性心脏刺激的需求与次要终点相关。
总体而言，纳入了144例患者。达到主要终点的患者主动脉瓣钙化评分并无显著更高（2936±1235 vs. 3051±1440，P = 0.93）。在排除有起搏器植入史或左束支传导阻滞的受试者后分析的106例患者中，主动脉瓣钙化评分与传导障碍的发生无统计学关联（3210±1436 vs. 2948±1223，P = 0.31）。
我们的结果表明，使用新一代瓣膜进行TAVR后，主动脉瓣钙化评分的测量对死亡率、心血管事件或传导障碍没有预后价值。
