新一代Evolut (PRO/PRO+/FX)自膨胀阀的优化超大尺寸:多中心研究。

IF 7.4 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS
Silvia Mas-Peiro, Alberto Alperi, Ander Regueiro, Ignacio Cruz-Gonzalez, Domenico Angellotti, Francisco Campelo-Parada, Marina Urena, Pablo Avanzas, Pablo Vidal-Cales, Gilles Jose Barreira de Sousa, Giovanni Esposito, Mehdi Tamir, Gaspard Suc, Anthony Poulin, Siamak Mohammadi, Marisa Avvedimento, Josep Rodés-Cabau
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引用次数: 0

摘要

背景:经导管主动脉瓣置换术后瓣旁泄漏(PVL)对预后有重要影响,瓣膜过大,特别是自膨胀瓣膜,可能会预防术后PVL的发生。Evolut阀门系统的最新迭代旨在减少PVL,但这种阀门的超大尺寸对PVL的影响在很大程度上是未知的。我们的目的是评估,在现实世界的当代设置,Evolut瓣膜过大对经导管主动脉瓣置换术后PVL的影响。方法:采用Evolut PRO/PRO+/FX瓣膜行经导管主动脉瓣置换术的患者进行多中心双视角观察研究。主动脉环周长,由多探测器计算机断层扫描确定,用来估计过大的程度。主要终点是在出院时通过超声心动图确定的PVL(轻度/中度-重度)的存在。次要终点包括由瓣膜学术研究联盟-3推荐定义的住院结果。结果:共纳入762例患者(Evolut PRO/PRO+/FX, 55.5%/34.8%/9.7%),瓣膜过大中位数为20(17-25)%,低(≤20%,n=381)和高(>20%,n=381)瓣膜过大者的基线特征无差异。住院死亡率和卒中发生率分别为2.4%和4.3%,临床结果没有与超大尺寸相关的差异。低(19.4%)和高(15.8%)瓣膜过大患者的永久性起搏器率相似,P=0.21。35.6%的患者出现PVL(轻度:32.6%,中重度:3.0%),轻度(40.9%)和重度(30.2%)患者PVL的发生率较高,P=0.002。在一项多变量分析中,较高的过大度与较低的PVL风险相关(过大度每增加1%的优势比为0.95 [0.92-0.99],P=0.006)。结论:在最近Evolut瓣膜迭代(PRO/PRO+/FX)的经导管主动脉瓣置换术中,较高的过大程度与较低的PVL频率相关,而不会增加其他并发症(包括永久性起搏器)的风险。这些数据表明,当使用Evolut阀门时,应避免低程度的阀门过径,特别是在临界情况下。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Optimal Oversizing With the New-Generation Evolut (PRO/PRO+/FX) Self-Expanding Valves: A Multicenter Study.

Background: Paravalvular leaks (PVLs) after transcatheter aortic valve replacement have a significant prognostic impact, and valve oversizing, particularly with self-expanding valves, may prevent postprocedural PVL occurrence. Recent iterations of the Evolut valve system are intended to reduce PVL, but the effects of oversizing with such valves on PVL are largely unknown. We aimed to assess, in a real-world contemporary setting, the impact of Evolut valve oversizing on PVL after transcatheter aortic valve replacement.

Methods: This was a multicenter observational ambispective study of patients undergoing transcatheter aortic valve replacement with the Evolut PRO/PRO+/FX valves. Aortic annulus perimeter, as determined by multidetector computed tomography, was used to estimate the oversizing degree. The primary end point was the presence of PVL (mild/moderate-severe), as determined by echocardiography at hospital discharge. Secondary end points included in-hospital outcomes as defined by the Valve Academic Research Consortium-3 recommendations.

Results: A total of 762 patients were included (Evolut PRO/PRO+/FX, 55.5%/34.8%/9.7%), and the median valve oversizing was 20 (17-25)%, with no differences in baseline characteristics between low (≤20%, n=381) and high (>20%, n=381) valve oversizing recipients. In-hospital mortality and stroke rates were 2.4% and 4.3%, respectively, with no oversizing-related differences in clinical outcomes. Permanent pacemaker rates were similar in patients with low (19.4%) and high (15.8%) valve oversizing, P=0.21. PVL was found in 35.6% of patients (mild: 32.6%, moderate-severe: 3.0%), with a higher incidence of PVL in patients with low (40.9%) versus high (30.2%) oversizing, P=0.002. In a multivariable analysis, a higher oversizing degree was associated with a lower risk of PVL (odds ratio, 0.95 [0.92-0.99] for each 1% increase in oversizing, P=0.006).

Conclusions: In transcatheter aortic valve replacement with recent Evolut valve iterations (PRO/PRO+/FX), a higher oversizing degree was associated with a lower frequency of PVL without increasing the risk of other complications (including permanent pacemaker). These data suggest that a low degree of valve oversizing should probably be avoided when using Evolut valves, particularly in borderline cases.

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来源期刊
Circulation: Cardiovascular Interventions
Circulation: Cardiovascular Interventions CARDIAC & CARDIOVASCULAR SYSTEMS-
CiteScore
10.30
自引率
1.80%
发文量
221
审稿时长
6-12 weeks
期刊介绍: Circulation: Cardiovascular Interventions, an American Heart Association journal, focuses on interventional techniques pertaining to coronary artery disease, structural heart disease, and vascular disease, with priority placed on original research and on randomized trials and large registry studies. In addition, pharmacological, diagnostic, and pathophysiological aspects of interventional cardiology are given special attention in this online-only journal.
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