经导管主动脉瓣置换术后左室流出道梗阻的发生率、预测因素和预后影响

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

CJC Open Pub Date : 2025-09-01 DOI:10.1016/j.cjco.2025.05.020

Yuta Kobayashi MD, PhD , Yusuke Enta MD , Masaki Nakashima MD , Makoto Saigan MD , Natsuko Satomi MD , Yung Teng MD , Daishi Tazawa MD , Yoshiko Munehisa MD, PhD , Masataka Taguri PhD , Masaki Hata MD , Norio Tada MD, PhD

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This study aimed to clarify the incidence and identify the predictors of LVOTO following TAVR and to investigate whether LVOTO is associated with clinical outcomes.</div></div><div><h3>Methods</h3><div>This retrospective, single-centre study analyzed 2068 consecutive patients with aortic stenosis who underwent TAVR between January 2014 and December 2023. Transthoracic echocardiography was performed both before and after TAVR. LVOTO was defined as a peak pressure gradient exceeding 30 mm Hg.</div></div><div><h3>Results</h3><div>LVOTO occurred in 25 of 1963 patients (1.3%), with 6 patients developing acute hemodynamic compromise immediately after TAVR. 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引用次数: 0

摘要

背景经导管主动脉瓣置换术（TAVR）后动态左心室流出道梗阻（LVOTO）是一种潜在的并发症，可导致严重的血流动力学不稳定。然而，关于tavr后LVOTO的发生率和预测因素的证据有限。本研究旨在明确TAVR后LVOTO的发生率和预测因素，并探讨LVOTO是否与临床结果相关。方法本回顾性单中心研究分析了2014年1月至2023年12月期间接受TAVR治疗的2068例连续主动脉瓣狭窄患者。TAVR前后均行经胸超声心动图检查。结果1963例TAVR患者中有25例（1.3%）发生了LVOTO，其中6例在TAVR后立即发生了急性血流动力学损害。最小绝对收缩和选择算子惩罚回归分析确定左室流出道尺寸（LVOTD）、室间隔（IVS）厚度、经瓣速度、LVOT最大速度（Vmax）和主动脉环与LVOT面积比（A/L ratio）是TAVR后LVOTO的独立预测因子。Kaplan-Meier分析显示TAVR后LVOTO与全因死亡率或心力衰竭再住院无关联。结论TAVR术后LVOTO发生率为1.27%。LVOTO的预测因子为IVS厚度、经瓣速度、LVOTD、LVOT Vmax和A/L比值。值得注意的是，TAVR后的LVOTO与全因死亡率或心力衰竭住院治疗的综合结果无关。

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Incidence, Predictors, and Prognostic Impact of Left Ventricular Outflow Tract Obstruction Following Transcatheter Aortic Valve Replacement

Background

Dynamic left ventricular outflow tract obstruction (LVOTO) following transcatheter aortic valve replacement (TAVR) is a potential complication that can cause severe hemodynamic instability. However, limited evidence is available regarding the incidence and predictors of LVOTO post-TAVR. This study aimed to clarify the incidence and identify the predictors of LVOTO following TAVR and to investigate whether LVOTO is associated with clinical outcomes.

Methods

This retrospective, single-centre study analyzed 2068 consecutive patients with aortic stenosis who underwent TAVR between January 2014 and December 2023. Transthoracic echocardiography was performed both before and after TAVR. LVOTO was defined as a peak pressure gradient exceeding 30 mm Hg.

Results

LVOTO occurred in 25 of 1963 patients (1.3%), with 6 patients developing acute hemodynamic compromise immediately after TAVR. Least absolute shrinkage and selection operator-penalized regression analysis identified the left ventricular outflow tract dimension (LVOTD), interventricular septum (IVS) thickness, transvalvular velocity, LVOT maximum velocity (V_max), and aortic annulus-to-LVOT area ratio (A/L ratio) as independent predictors of LVOTO following TAVR. Kaplan-Meier analysis revealed no association between LVOTO following TAVR and all-cause mortality or rehospitalization for heart failure.

Conclusions

The incidence of LVOTO after TAVR was 1.27%. Predictors of LVOTO were the IVS thickness, transvalvular velocity, LVOTD, LVOT V_max, and A/L ratio. Notably, LVOTO following TAVR was not associated with the composite outcome of all-cause mortality or heart failure hospitalization.

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