Geometric changes in ventriculoaortic complex after transcatheter aortic valve replacement and its association with post-procedural prosthesis–patient mismatch: an intraprocedural 3D-TEE study
Geometric changes in ventriculoaortic complex after transcatheter aortic valve replacement and its association with post-procedural prosthesis–patient mismatch: an intraprocedural 3D-TEE study
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经导管主动脉瓣置换术后心室主动脉复合体的几何变化及其与术后假体-患者不匹配的关系：一项术中 3D-TEE 研究
DOI：
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发表时间：
2017
影响因子：
6.2
通讯作者：
T. Shiota
中科院分区：
文献类型：
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作者：
Hiroto Utsunomiya;Hirotsugu Mihara;Y. Itabashi;Sayuki Kobayashi;R. Siegel;T. Chakravarty;H. Jilaihawi;R. Makkar;T. Shiota
目的：经导管主动脉瓣置换术（TAVR）后假体-患者不匹配（PPM）导致死亡率增加。然而，其围手术期决定因素仍然未知。我们通过三维经食管超声心动图（3D-TEE）研究了TAVR期间主动脉瓣环（AoA）和左心室流出道（LVOT）的几何变化及其与术后PPM的相关性。方法和结果共有131例重度主动脉瓣狭窄患者在球囊扩张式TAVR期间接受了术中3D-TEE。使用出院时多普勒超声心动图计算的有效瓣口面积指数对PPM的严重程度进行分级，中度定义为≥0.65且<0.85 cm 2/m2，重度定义为<0.65 cm 2/m2。TAVR后3D平面测量的AoA面积减少（P< 0.001），而LVOT增加（P= 0.004）。TAVR术后AoA和LVOT偏心率均降低（均P< 0.001）。出院时，总体和重度PPM的发生率分别为44%和12%。PPM患者的体表面积较大，主动脉瓣面积较小，球囊扩张次数较少（均P< 0.05）。PPM患者的TAVR后AoA面积/TAVR前AoA面积（91 ± 8 vs. 95 ± 7%，P= 0.001）低于无PPM患者。TAVR后AoA面积/TAVR前AoA面积与总体PPM（比值比，1.80; 95% CI，1.06-3.05; P= 0.031）和重度PPM（比值比，2.50; 95% CI，1.05-5.36; P= 0.04）独立相关。此外，该比率>86.3%的截止值对于预防严重PPM具有84%的灵敏度和44%的特异性。结论3D-TEE可评价球囊扩张式TAVR术中主动脉瓣口和左室流出道的几何变化，并预测术后PPM。
Aims Prosthesis–patient mismatch (PPM) after transcatheter aortic valve replacement (TAVR) leads to increased mortality. However, its peri-procedural determinants remain unknown. We investigated geometric changes in aortic annulus (AoA) and left ventricular outflow tract (LVOT) during TAVR by three-dimensional transoesophageal echocardiography (3D-TEE) and its association with post-procedural PPM. Methods and results A total of 131 patients with severe aortic stenosis underwent intraprocedural 3D-TEE during balloon-expandable TAVR. The severity of PPM was graded using the indexed effective orifice area calculated by Doppler echocardiography at discharge, with moderate defined as ≥0.65 and ⩽0.85 cm2/m2 and severe defined as <0.65 cm2/m2. 3D planimetered AoA area decreased after TAVR (P< 0.001), whereas the LVOT increased (P= 0.004). The eccentricity of both AoA and LVOT decreased after TAVR (both, P< 0.001). At discharge, the incidence of overall and severe PPM was 44 and 12%, respectively. Patients with PPM had a larger body surface area, smaller aortic valve area, and less frequent balloon dilation (all P< 0.05). Patients with PPM had a lower post-TAVR AoA area/pre-TAVR AoA area (91 ± 8 vs. 95 ± 7%, P= 0.001) than those without PPM. The post-TAVR AoA area/pre-TAVR AoA area was independently associated with overall PPM (odds ratio, 1.80; 95% CI, 1.06–3.05; P= 0.031) and severe PPM (odds ratio, 2.50; 95% CI, 1.05–5.36; P= 0.04). Additionally, a cut-off value of this ratio >86.3% had a sensitivity of 84% and a specificity of 44% for the prevention of severe PPM. Conclusion 3D-TEE can evaluate geometric changes in AoA and LVOT during balloon-expandable TAVR and predicts post-procedural PPM.
经导管和外科主动脉瓣置换术治疗严重主动脉瓣狭窄的比较：PARTNER 试验 A 组超声心动图参数的纵向研究（经导管主动脉瓣膜置入）。
影响因子：
24
作者：
Hahn, Rebecca T.;Pibarot, Philippe;Stewart, William J.;Weissman, Neil J.;Gopalakrishnan, Deepika;Keane, Martin G.;Anwaruddin, Saif;Wang, Zuyue;Bilsker, Martin;Lindman, Brian R.;Herrmann, Howard C.;Kodali, Susheel K.;Makkar, Raj;Thourani, Vinod H.;Svensson, Lars G.;Akin, Jodi J.;Anderson, William N.;Leon, Martin B.;Douglas, Pamela S.
通讯作者：
Douglas, Pamela S.