Hammerer Matthias, Hasenbichler Philipp, Schörghofer Nikolaos, Knapitsch Christoph, Clodi Nikolaus, Hoppe Uta C, Hergan Klaus, Boxhammer Elke, Scharinger Bernhard
Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria.
Department of Radiology, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria.
J Cardiovasc Dev Dis. 2025 Aug 1;12(8):296. doi: 10.3390/jcdd12080296.
Transcatheter aortic valve implantation (TAVI) has revolutionized the treatment of severe aortic valve stenosis (AS). Balloon post-dilatation (PD) remains an important procedural step to optimize valve function by resolving incomplete valve expansion, which may lead to paravalvular regurgitation and other potentially adverse effects. There are only limited data on the predictors, incidence, and clinical impact of PD during TAVI.
This retrospective, single-center study analyzed 585 patients who underwent TAVI (2016-2022). Pre-procedural evaluations included transthoracic echocardiography and CT angiography to assess key parameters, including the aortic valve calcium score (AVCS); aortic valve calcium density (AVCd); aortic valve maximal systolic transvalvular flow velocity (AV Vmax); and aortic valve mean systolic pressure gradient (AV MPG). We identified imaging predictors of PD and evaluated associated clinical outcomes by analyzing procedural endpoints (according to VARC-3 criteria) and long-term survival.
PD was performed on 67 out of 585 patients, with elevated AV Vmax (OR: 1.424, 95% CI: 1.039-1.950; = 0.028) and AVCd (OR: 1.618, 95% CI: 1.227-2.132; = 0.001) emerging as a significant independent predictor for PD in TAVI. Kaplan-Meier survival analysis revealed no significant differences in short- and mid-term survival between patients who underwent PD and those who did not. Interestingly, patients requiring PD exhibited a lower incidence of adverse events regarding major vascular complications, permanent pacemaker implantations and stroke.
The study highlights AV Vmax and AVCd as key predictors of PD. Importantly, PD was not associated with increased procedural adverse events and did not predict adverse events in this contemporary cohort.
经导管主动脉瓣植入术（TAVI）彻底改变了严重主动脉瓣狭窄（AS）的治疗方式。球囊后扩张（PD）仍然是一个重要的手术步骤，通过解决瓣膜扩张不完全的问题来优化瓣膜功能，瓣膜扩张不完全可能导致瓣周反流和其他潜在的不良影响。关于TAVI期间PD的预测因素、发生率和临床影响的数据有限。
这项回顾性单中心研究分析了585例接受TAVI的患者（2016 - 2022年）。术前评估包括经胸超声心动图和CT血管造影，以评估关键参数，包括主动脉瓣钙化评分（AVCS）、主动脉瓣钙化密度（AVCd）、主动脉瓣最大收缩期跨瓣血流速度（AV Vmax）和主动脉瓣平均收缩期压力阶差（AV MPG）。我们确定了PD的影像学预测因素，并通过分析手术终点（根据VARC - 3标准）和长期生存率来评估相关的临床结果。
585例患者中有67例进行了PD，AV Vmax升高（OR：1.424，95%CI：1.039 - 1.950；P = 0.028）和AVCd升高（OR：1.618，95%CI：1.227 - 2.132；P = 0.001）成为TAVI中PD的显著独立预测因素。Kaplan - Meier生存分析显示，接受PD的患者与未接受PD的患者在短期和中期生存率上没有显著差异。有趣的是，需要PD的患者在主要血管并发症、永久性起搏器植入和中风等不良事件的发生率较低。
该研究强调AV Vmax和AVCd是PD的关键预测因素。重要的是，在这个当代队列中，PD与手术不良事件增加无关，也不能预测不良事件。
