Bjursten Henrik, Koul Sasha, Duvernoy Olov, Fagman Erika, Samano Ninos, Nilsson Johan, Nielsen Niels Erik, Rück Andreas, Johansson Jan, James Stefan, Settergren Magnus, Götberg Matthias, Pistea Adrian
Department of Cardiothoracic Surgery, Skåne University Hospital, Lund University, Lund, Sweden.
Department of Clinical Sciences Lund, Cardiology, Skåne University Hospital, Lund University, Lund, Sweden.
Struct Heart. 2022 Aug 3;6(4):100070. doi: 10.1016/j.shj.2022.100070. eCollection 2022 Aug.
Periprocedural stroke during transcatheter aortic valve implantation is a rare but devastating complication. The calcified aortic valve is the most likely source of the emboli in a periprocedural stroke. The total load and distribution of calcium in the leaflets, aortic root, and left ventricular outflow tract varies from patient to patient. Consequently, there could be patterns of calcification that are associated with a higher risk of stroke. This study aimed to explore whether the pattern of calcification in the left ventricular outflow tract, annulus, aortic valve, and ascending aorta can be used to predict a periprocedural stroke.
Among the 3282 consecutive patients who received a transcatheter aortic valve implantation in the native valve in Sweden from 2014 to 2018, we identified 52 who had a periprocedural stroke. From the same cohort, a control group of 52 patients was constructed by propensity score matching. Both groups had one missing cardiac computed tomography, and 51 stroke and 51 control patients were blindly reviewed by an experienced radiologist.
The groups were well balanced in terms of demographics and procedural data. Of the 39 metrics created to describe calcium pattern, only one differed between the groups. The length of calcium protruding above the annulus was 10.6 mm (interquartile range 7-13.6) for patients without stroke and 8 mm (interquartile range 3-10) for stroke patients.
This study could not find any pattern of calcification that predisposes for a periprocedural stroke.
经导管主动脉瓣植入术中围手术期卒中是一种罕见但具有毁灭性的并发症。钙化的主动脉瓣是围手术期卒中栓子最可能的来源。瓣叶、主动脉根部和左心室流出道中钙的总负荷和分布因患者而异。因此，可能存在与较高卒中风险相关的钙化模式。本研究旨在探讨左心室流出道、瓣环、主动脉瓣和升主动脉的钙化模式是否可用于预测围手术期卒中。
在2014年至2018年于瑞典接受经导管主动脉瓣植入术治疗原生瓣膜的3282例连续患者中，我们确定了52例发生围手术期卒中的患者。从同一队列中，通过倾向评分匹配构建了一个由52例患者组成的对照组。两组均有一次心脏计算机断层扫描缺失，由一位经验丰富的放射科医生对51例卒中患者和51例对照患者进行盲法评估。
两组在人口统计学和手术数据方面平衡良好。在为描述钙化模式而创建的39项指标中，两组之间仅一项存在差异。无卒中患者瓣环上方钙突出的长度为10.6毫米（四分位间距7 - 13.6），卒中患者为8毫米（四分位间距3 - 10）。
本研究未发现任何易导致围手术期卒中的钙化模式。
