Department of Cardiology, Mardin Training and Research Hospital, Mardin, Turkey.
Department of Cardiology, Faculty of Medicine, Dicle University, Diyarbakır, Turkey.
Braz J Cardiovasc Surg. 2024 Mar 1;39(2):e20220436. doi: 10.21470/1678-9741-2022-0436.
The aim of this study was to assess the impact of aortic angulation (AA) on periprocedural and in-hospital complications as well as mortality of patients undergoing Evolut™ R valve implantation.
A retrospective study was conducted on 264 patients who underwent transfemoral-approach transcatheter aortic valve replacement with self-expandable valve at our hospital between August 2015 and August 2022. These patients underwent multislice computer tomography scans to evaluate AA. Transcatheter aortic valve replacement endpoints, device success, and clinical events were assessed according to the definitions provided by the Valve Academic Research Consortium-3. Cumulative events included paravalvular leak, permanent pacemaker implantation, new-onset stroke, and in-hospital mortality. Patients were divided into two groups, AA ≤ 48° and AA > 48°, based on the mean AA measurement (48.3±8.8) on multislice computer tomography.
Multivariable logistic regression analysis was performed to identify predictors of cumulative events, utilizing variables with a P-value < 0.2 obtained from univariable logistic regression analysis, including AA, age, hypertension, chronic renal failure, and heart failure. AA (odds ratio [OR]: 1.73, 95% confidence interval [CI]: 0.89-3.38, P=0.104), age (OR: 1.04, 95% CI: 0.99-1.10, P=0.099), hypertension (OR: 1.66, 95% CI: 0.82-3.33, P=0.155), chronic renal failure (OR: 1.82, 95% CI: 0.92-3.61, P=0.084), and heart failure (OR: 0.57, 95% CI: 0.27-1.21, P=0.145) were not found to be significantly associated with cumulative events in the multivariable logistic regression analysis.
This study demonstrated that increased AA does not have a significant impact on intraprocedural and periprocedural complications of patients with new generation self-expandable valves implanted.
本研究旨在评估主动脉成角（AA）对接受 Evolut™ R 瓣膜植入的患者围手术期和院内并发症以及死亡率的影响。
对 2015 年 8 月至 2022 年 8 月期间在我院接受经股动脉途径经导管主动脉瓣置换术（TAVR）的 264 例患者进行回顾性研究。这些患者接受多层计算机断层扫描（CT）以评估 AA。根据 Valve Academic Research Consortium-3 提供的定义评估 TAVR 终点、器械成功率和临床事件。累积事件包括瓣周漏、永久性起搏器植入、新发卒中以及院内死亡率。根据多层 CT 上测量的平均 AA（48.3±8.8）将患者分为 AA≤48°和 AA＞48°两组。
多变量逻辑回归分析用于识别累积事件的预测因素，包括 AA、年龄、高血压、慢性肾衰竭和心力衰竭等变量，使用单变量逻辑回归分析中 P 值<0.2 的变量。AA（比值比 [OR]：1.73，95%置信区间 [CI]：0.89-3.38，P=0.104）、年龄（OR：1.04，95%CI：0.99-1.10，P=0.099）、高血压（OR：1.66，95%CI：0.82-3.33，P=0.155）、慢性肾衰竭（OR：1.82，95%CI：0.92-3.61，P=0.084）和心力衰竭（OR：0.57，95%CI：0.27-1.21，P=0.145）在多变量逻辑回归分析中与累积事件无显著相关性。
本研究表明，对于植入新一代自膨式瓣膜的患者，AA 增加并不会显著影响围手术期和手术过程中的并发症。
