Natural History of Leaflet Thrombosis After Transcatheter Aortic Valve Replacement: A 5-Year Follow-Up Study.
Natural History of Leaflet Thrombosis After Transcatheter Aortic Valve Replacement: A 5-Year Follow-Up Study.
复制标题
经导管主动脉瓣置换术后瓣叶血栓形成的自然史：一项5年随访研究。
DOI：
10.1161/jaha.122.026334
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发表时间：
2022-12-06
影响因子：
5.4
通讯作者：
Fukuda, Keiichi
中科院分区：
文献类型：
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作者：
Imaeda, Shohei;Inohara, Taku;Yoshijima, Nobuhiro;Kobari, Yusuke;Myojin, Sosuke;Ryuzaki, Toshinobu;Hattori, Osamu;Shinada, Keitaro;Tsuruta, Hikaru;Takahashi, Tatsuo;Yamazaki, Masataka;Kato, Jungo;Yamada, Yoshitake;Jinzaki, Masahiro;Shimizu, Hideyuki;Hayashida, Kentaro;Fukuda, Keiichi
经导管主动脉瓣置换术（TAVR）后常见亚临床瓣叶血栓形成，其特征为多层螺旋CT显示的瓣叶低衰减增厚（HALT）。由于对亚临床HALT的长期自然史知之甚少，我们旨在对接受TAVR而未使用额外抗凝的患者进行研究。我们回顾性评价了2013年10月至2015年12月期间在我院使用Edwards SAPIEN‐XT进行TAVR的患者。根据TAVR后1年内是否存在HALT对患者进行分组（HALT组和无HALT组）。比较了主要结局，定义为全因死亡率、心力衰竭再入院和缺血性卒中的复合终点。通过经胸超声心动图评估瓣膜性能随时间的变化。在124例患者（男性：29.1%;中位年龄：85岁）中，27例（21.8%）在TAVR后1年内的多探测器计算机断层扫描显示HALT。由于没有瓣膜相关症状恶化，没有患者需要额外抗凝治疗HALT。在4.7年的中位随访期内（四分位距，4.0-5.6），两组的主要结局率和瓣膜性能无统计学差异（分别为37.0%和38.1%;对数秩检验P=0.92;平均压差，9 mm Hg [8-14 mm Hg]和10 mm Hg [7-15 mm Hg]; P=0.51）。TAVR后约20%的患者在1年内发生HALT;然而，尽管没有额外的抗凝治疗，但这并没有改变随后不良心血管事件的风险或长达5年的瓣膜性能，具有统计学意义。
Subclinical leaflet thrombosis, characterized by hypoattenuated leaflet thickening (HALT) on multidetector computed tomography, is common after transcatheter aortic valve replacement (TAVR). Because little is known about the long‐term natural history of subclinical HALT, we aimed to investigate this in patients who underwent TAVR without using additional anticoagulation. We retrospectively evaluated patients who underwent TAVR with the Edwards SAPIEN‐XT at our institute between October 2013 and December 2015. Patients were grouped according to the presence or absence of HALT within 1 year after TAVR (HALT and No‐HALT groups). The primary outcome, defined as the composite of all‐cause mortality, heart failure readmission, and ischemic stroke, was compared. Valve performance was assessed over time by transthoracic echocardiography. Among 124 patients (men: 29.1%; median age, 85 years), 27 (21.8%) showed HALT on multidetector computed tomography within 1 year after TAVR. No patient required additional anticoagulation for treating HALT because of the absence of valve‐related symptomatic deterioration. During the median follow‐up period of 4.7 years (interquartile range, 4.0–5.6), the rate of primary outcome and valve performance was not statistically different between the 2 groups (37.0% versus 38.1%; log‐rank test P=0.92; mean pressure gradient, 9 mm Hg [8–14 mm Hg] versus 10 mm Hg [7–15 mm Hg]; P=0.51, respectively). Approximately 20% of patients after TAVR had HALT within 1 year; however, that did not change the risk of subsequent adverse cardiovascular events or the valve performance with statistical significance for up to 5 years despite no additional anticoagulation therapy.