Department of Cardiovascular Medicine, Kitasato University.
Department of Healthcare Quality Assessment, Graduate School of Medicine, the University of Tokyo.
Circ J. 2021 Jun 25;85(7):967-976. doi: 10.1253/circj.CJ-20-1084. Epub 2021 Feb 27.
The details and consequences of a small aortic annulus among transcatheter aortic valve replacement (TAVR) patients remain uncertain. This study investigated the short-term outcomes in patients with small annular size and compared the 30-day outcome between intra- and supra-annular devices, with similar outer casing diameter in this subgroup.
Cases registered in the Japanese national TAVR registry between August 2013 and December 2017 were analyzed. Among a total of 5,870 registered patients, 647 (11.0%) had small annulus (area ≤314 mm) measured by multi-detector computed tomography. Patients with a small annulus had a significantly smaller indexed effective orifice area (iEOA, 1.10 cm/m[0.92-1.35] vs. 1.16 cm/m[0.96-1.39], P<0.001) and higher mean pressure gradient (mPG, 10.0 mmHg [6.9-14.2] vs. 8.5 mmHg [6.0-11.5], P<0.001) compared with a normal-sized annulus. Among patients with a small annulus, those receiving a 20 mm intra-annular device had a smaller iEOA (0.94 cm/m[0.78-1.06] vs. 1.07 cm/m[0.8-1.24], P=0.001) and higher mPG (14.0 mmHg [10.0-18.5] vs. 11.0 [7.0-14.0], P<0.001) compared with those receiving a 23-mm supra-annular device, although the incidence of paravalvular leakage (≥moderate) was similar (14.4% vs. 16.5%, P=0.69).
Patients with a small annulus were associated with less hemodynamic improvement. A supra-annular device is associated with better echocardiographic improvement in patients with a small annulus, without increasing paravalvular leakage.
经导管主动脉瓣置换术（TAVR）患者的主动脉瓣环较小的具体细节和后果仍不确定。本研究调查了小瓣环患者的短期结果，并比较了在这个亚组中外壳直径相似的瓣中瓣和瓣上装置的 30 天结果。
分析了 2013 年 8 月至 2017 年 12 月期间在日本国家 TAVR 注册中心登记的病例。在总共登记的 5870 例患者中，647 例（11.0%）的多探测器计算机断层扫描测量的瓣环较小（面积≤314mm）。瓣环较小的患者的有效瓣口面积指数（iEOA，1.10cm/m[0.92-1.35]比 1.16cm/m[0.96-1.39]，P<0.001）和平均压力梯度（mPG，10.0mmHg[6.9-14.2]比 8.5mmHg[6.0-11.5]，P<0.001）显著更高。在小瓣环患者中，接受 20mm 瓣中瓣装置的患者的 iEOA 更小（0.94cm/m[0.78-1.06]比 1.07cm/m[0.8-1.24]，P=0.001）和 mPG 更高（14.0mmHg[10.0-18.5]比 11.0mmHg[7.0-14.0]，P<0.001），而接受 23mm 瓣上装置的患者则相反，尽管瓣周漏（≥中度）的发生率相似（14.4%比 16.5%，P=0.69）。
瓣环较小的患者血流动力学改善较少。在小瓣环患者中，瓣上装置与更好的超声心动图改善相关，而不会增加瓣周漏。
