经导管主动脉瓣置换术（TAVI）中瓣中瓣生物瓣膜破裂：Perimount主动脉生物瓣膜衰败的临床和超声心动图结果——一项多中心注册研究
Bioprosthetic Valve Fracturing in Valve-in-Valve TAVI: Clinical and Echocardiographic Outcomes in Failing Perimount Aortic Bioprostheses-A Multicenter Registry.
作者信息
Ruge Hendrik, Burri Melchior, Schreyer Julia, Georgescu Teodora-Cristiana, Frank Derk, Kim Won-Keun, de Backer Ole, Beyer Martin, Schäfer Andreas, Fraccaro Chiara, Tarantini Giuseppe, Xhepa Erion, Joner Michael, Krane Markus, Covarrubias Héctor Alfonso Alvarez
机构信息
Department of Cardiovascular Surgery, Institute Insure, German Heart Center Munich, School of Medicine & Health, Technical University of Munich, Munich, Germany.
German Center for Cardiovascular Research (DZHK), partner side Hamburg/Kiel/Lübeck, Kiel, Germany.
出版信息
Catheter Cardiovasc Interv. 2025 Aug;106(2):1409-1420. doi: 10.1002/ccd.31686. Epub 2025 Jun 19.
BACKGROUND
Data comparing clinical and hemodynamic outcomes of bioprosthetic valve fracturing (BVF) and "standard"-postdilatation during valve-in-valve transcatheter heart valve implantation (ViV-TAVI) are lacking. The authors aimed to analyze hemodynamic and clinical outcomes of BVF compared to "standard"-postdilatation during ViV-TAVI.
METHODS
The REDUCE registry included patients who underwent ViV-TAVI within a Perimount surgical aortic valve bioprosthesis (Edwards Lifesciences, USA). Procedures were categorized to no postdilatation, "standard"-postdilatation and BVF. Hemodynamic and clinical outcomes at 30 days were collected and compared. A linear regression model was built to predict mean aortic gradient after ViV-TAVI.
RESULTS
A total of 240 patients from six European sites were included. Median age was 78 years [IQR 70; 83], logistic EuroSCORE calculated 20.0%[IQR 12.2; 33.1] and 159 patients (66%) were male. One hundred fourty-four Perimount valves (60%) had a true internal diameter (ID) ≤ 21 mm. Self-expanding valves (SEV) and ballon-expandable valves (BEV) were used in 60% and 40% of cases, respectively. One hundred sixteen procedures (48%) were executed without postdilatation, in 88 procedures (37%) "standard"-postdilatation and in 36 procedures (15%) BVF was used. 30-day survival was 93.3%. VARC-3 device success at 30 days was 71%. A multivariable regression analysis of the mean aortic gradient after ViV-TAVI showed a significant association with surgical valve size (-0.84 mmHg, p = 0.001; per 1 mm surgical valve size increase), execution of postdilatation (-3.25 mmHg, p = 0.007) and type of transcatheter heart valve (SEV: -7.31 mmHg, p < 0.001).
CONCLUSIONS
When performing ViV-TAVI within a Perimount surgical aortic bioprosthesis with a true ID ≤ 21 mm, the hemodynamic valve performance is most optimal when implanting a SEV-TAV and when postdilating the TAV-in-SAV complex. BVF did not result in superior hemodynamics compared to "standard"-postdilatation.
背景
缺乏关于生物瓣破裂（BVF）与经导管心脏瓣膜植入术（ViV-TAVI）中“标准”后扩张术的临床和血流动力学结果比较的数据。作者旨在分析ViV-TAVI期间BVF与“标准”后扩张术的血流动力学和临床结果。
方法
REDUCE注册研究纳入了在Perimount外科主动脉瓣生物瓣（美国爱德华兹生命科学公司）内行ViV-TAVI的患者。手术分为无后扩张术、“标准”后扩张术和BVF。收集并比较30天时的血流动力学和临床结果。建立线性回归模型以预测ViV-TAVI后的平均主动脉瓣压差。
结果
共纳入来自6个欧洲中心的240例患者。中位年龄为78岁[四分位间距70；83]，逻辑EuroSCORE评分为20.0%[四分位间距12.2；33.1]，159例患者（66%）为男性。144个Perimount瓣膜（60%）的实际内径（ID）≤21mm。分别有60%和40%的病例使用了自膨胀瓣膜（SEV）和球囊扩张瓣膜（BEV）。116例手术（48%）未行后扩张术，88例手术（37%）采用“标准”后扩张术，36例手术（15%）采用BVF。30天生存率为93.3%。30天时VARC-3器械成功率为71%。对ViV-TAVI后的平均主动脉瓣压差进行多变量回归分析显示，其与外科瓣膜尺寸（-0.84mmHg；P=0.001；外科瓣膜尺寸每增加1mm）、后扩张术的实施（-3.25mmHg；P=0.007）及经导管心脏瓣膜类型（SEV：-7.31mmHg；P<0.001）显著相关。
结论
在实际内径≤21mm的Perimount外科主动脉生物瓣内行ViV-TAVI时，植入SEV-TAV并对TAV-in-SAV复合体进行后扩张时，血流动力学瓣膜性能最佳。与“标准”后扩张术相比，BVF并未带来更优的血流动力学效果。
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