Incidence, Timing, and Predictors of Valve Hemodynamic Deterioration After Transcatheter Aortic Valve Replacement Multicenter Registry
Incidence, Timing, and Predictors of Valve Hemodynamic Deterioration After Transcatheter Aortic Valve Replacement Multicenter Registry
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DOI：
10.1016/j.jacc.2015.10.097
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发表时间：
2016-02-16
影响因子：
24
通讯作者：
Rodes-Cabau, Josep
中科院分区：
文献类型：
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作者：
Del Trigo, Maria;Munoz-Garcia, Antonio J.;Rodes-Cabau, Josep
背景关于经导管主动脉瓣置换术(TAVR)后瓣膜血流动力学恶化(VHD)的发生率和相关因素的数据很少。目的本研究试图确定大量接受TAVR的患者中VHD的发生率、发生时间和预测因素。超声心动图平均随访20+/-13个月(至少6个月)。分别于出院时、出院后6~12个月及以后每年进行超声心动图检查。平均梯度的年化变化(毫米汞柱/年)是通过将最后一次随访的平均梯度与出院时的梯度之间的差除以检查之间的时间来计算的。VHD被定义为与出院评估相比，随访期间假体平均坡度增加>；=10 mm Hg。结果随访期间假体平均坡度递增的年平均速率为0.30+/-4.99 mm Hg/年。共有68例患者符合VHD标准(随访期间发生率：4.5%)。出院时未进行抗凝治疗(p=0.002)、瓣膜置入手术(p=0.032)、使用23 mm瓣膜(p=0.016)和较大的体重指数(p=0.001)是VHD的独立预测因素。缺乏抗凝治疗、瓣膜置入手术、较大的体重指数和使用23 mm的经导管瓣膜与TAVR后较高的VHD发生率相关。需要进一步的前瞻性研究来确定TAVR后的特定抗血栓治疗是否可以降低VHD的风险。(C)2016年，由美国心脏病学院基金会提供。
BACKGROUND Scarce data exist on the incidence of and factors associated with valve hemodynamic deterioration (VHD) after transcatheter aortic valve replacement (TAVR).OBJECTIVES This study sought to determine the incidence, timing, and predictors of VHD in a large cohort of patients undergoing TAVR.METHODS This multicenter registry included 1,521 patients (48% male; 80 +/- 7 years of age) who underwent TAVR. Mean echocardiographic follow-up was 20 +/- 13 months (minimum: 6 months). Echocardiographic examinations were performed at discharge, at 6 to 12 months, and yearly thereafter. Annualized changes in mean gradient (mm Hg/year) were calculated by dividing the difference between the mean gradient at last follow-up and the gradient at discharge by the time between examinations. VHD was defined as a >= 10 mm Hg increase in transprosthetic mean gradient during follow-up compared with discharge assessment.RESULTS The overall mean annualized rate of transprosthetic gradient progression during follow-up was 0.30 +/- 4.99 mm Hg/year. A total of 68 patients met criteria of VHD (incidence: 4.5% during follow-up). The absence of anticoagulation therapy at hospital discharge (p = 0.002), a valve-in-valve (TAVR in a surgical valve) procedure (p = 0.032), the use of a 23-mm valve (p = 0.016), and a greater body mass index (p = 0.001) were independent predictors of VHD.CONCLUSIONS There was a mild but significant increase in transvalvular gradients over time after TAVR. The lack of anticoagulation therapy, a valve-in-valve procedure, a greater body mass index, and the use of a 23-mm transcatheter valve were associated with higher rates of VHD post-TAVR. Further prospective studies are required to determine whether a specific antithrombotic therapy post-TAVR may reduce the risk of VHD. (C) 2016 by the American College of Cardiology Foundation.