Ascending aortic dilatation rate after transcatheter aortic valve replacement in patients with bicuspid and tricuspid aortic stenosis: A multidetector computed tomography follow-up study
Ascending aortic dilatation rate after transcatheter aortic valve replacement in patients with bicuspid and tricuspid aortic stenosis: A multidetector computed tomography follow-up study
复制标题
二尖瓣和三尖瓣主动脉瓣狭窄患者经导管主动脉瓣置换术后升主动脉扩张率：多探测器计算机断层扫描随访研究。
DOI：
10.5847/wjem.j.1920-8642.2019.04.001
复制
发表时间：
2019-08-01
影响因子：
2.1
通讯作者：
Wang, Jian-an
中科院分区：
文献类型：
--
作者：
He, Yu-xin;Fan, Jia-qi;Wang, Jian-an
背景
目前有关二尖瓣和三尖瓣狭窄(AS)患者经导管主动脉瓣置换术(TAVR)后升主动脉扩张的进展缺乏相关资料。本研究旨在通过多层计算机断层扫描(MDCT)随访，评估BAV和TAV患者TAVR后升主动脉扩张率(mm/年)，并确定升主动脉扩张率的预测因素。
方法
纳入2013年3月至2018年3月在我们中心接受TAVR并进行MDCT随访的重症AS患者。用基线多层螺旋CT检测BAV和TAV。分析基线和随访的多层螺旋CT图像，测量升主动脉内径。研究终点为升主动脉扩张率(mm/年)。此外，还对预测升主动脉扩张率的因素进行了探讨。
结果
共纳入208例患者，其中BAV86例，TAV122例。分别对7名、9名、30名、46名和116名患者进行了5年、4年、3年、2年和1年的MDCT随访。升主动脉内径分别为(43.7±4.4)mm比(44.0±4.5)mm(P<0.001)和(39.1±4.8)mm比(39.7±5.1)mm(P<0.001)。升主动脉扩张率分别为(0.592.2±0.8)mm/年和(0.3±0.8)mm/年，差异无统计学意义(P=0.0 5)。多元线性回归分析显示，在全人群和BAV组中，瓣膜旁渗漏(PVL)分级与升主动脉扩张率独立相关，而与TAV组无关。随访期间未发生主动脉事件。
结论
BAV患者TAVR后升主动脉内径继续增大，但扩张率较轻，与TAV患者相当。BAV患者TAVR术后PVL分级与升主动脉扩张率相关。
BACKGROUND
Current data is lacking about the progression of ascending aortic dilatation after transcatheter aortic valve replacement (TAVR) in aortic stenosis (AS) patients with bicuspid aortic valve (BAV) and tricuspid aortic valve (TAV). This study aims to assess the ascending aortic dilatation rate (mm/year) after TAVR in patients with BAV versus TAV using a multidetector computed tomography (MDCT) follow-up and to determine the predictors of ascending aortic dilatation rate.
METHODS
Severe AS patients undergoing TAVR from March 2013 to March 2018 at our center with MDCT follow-ups were included. BAV and TAV were identified using baseline MDCT. Baseline and follow-up MDCT images were analyzed, and the diameters of ascending aorta were measured. Study end point is ascending aortic dilatation rate (mm/year). Furthermore, factors predicting ascending aortic dilatation rate were also investigated.
RESULTS
Two hundred and eight patients were included, comprised of 86 BAV and 122 TAV patients. Five, 4, 3, 2, and 1-year MDCT follow-ups were achieved in 7, 9, 30, 46, and 116 patients. The ascending aortic diameter was significantly increased after TAVR in both BAV group (43.7±4.4 mm vs. 44.0±4.5 mm; P<0.001) and TAV group (39.1±4.8 mm vs. 39.7±5.1 mm; P<0.001). However, no difference of ascending aortic dilatation rate was found between BAV and TAV group (0.2±0.8 mm/year vs. 0.3±0.8 mm/year, P=0.592). Multivariate linear regression revealed paravalvular leakage (PVL) grade was independently associated with ascending aortic dilatation rate in the whole population and BAV group, but not TAV group. No aortic events occurred during follow-ups.
CONCLUSION
Ascending aortic size continues to grow after TAVR in BAV patients, but the dilatation rate is mild and comparable to that of TAV patients. PVL grade is associated with ascending aortic dilatation rate in BAV patients post-TAVR.