相对左心室外流通道区域与跨导管大动脉替换相对膜泄漏的关联
Kartik Gupta1, Pedro Villablanca2, Pedro Engel Gonzalez2
1Division of Cardiovascular Diseases, Henry Ford Health, Detroit, Michigan.
概括
相对于环,较窄的左心室外流通道 (LVOT) 区域与跨导管大动脉置换 (TAVR) 后增加的准膜泄漏 (PVL) 有关. 优化LVOT大小可能会减少PVL并发症.
科学领域:
- 心血管医学 心血管医学
- 干预心脏病学 干预心脏病学
- 医疗成像医学成像
背景情况:
- 甲膜泄漏 (PVL) 透气管后大动脉替换 (TAVR) 是影响患者结果的关键质量指标.
- 目前的跨导管心脏 (THV) 尺寸依赖于环形尺寸,可能会忽视左心室外流管 (LVOT) 区域.
- 在LVOT尺寸和PVL风险之间的关系需要进一步调查.
研究的目的:
- 调查相对左心室外流管 (LVOT) 区域与TAVR后膜外泄漏 (PVL) 的发生率之间的联系.
- 确定与大动脉环相对的LVOT大小是否预测TAVR患者的PVL.
主要方法:
- 从2018年1月到2019年3月接受TAVR的293名患者的回顾性分析.
- 在TAVR前的多探测器计算机断层扫描 (MDCT) 用于计算相对LVOT面积 (LVOT面积/环形面积).
- 后勤回归分析,以评估相对LVOT面积与通过心声学检测的轻度或更大的PVL之间的关联.
主要成果:
- 相对LVOT面积增加1%与轻度或更大的PVL几率显著降低有关 (aOR,0.96;95% CI,0.93-0.98;P = .002).
- 在最高相对LVOT三位数的患者与最低三位数相比,PVL的几率明显较低 (aOR,0.42;95% CI,0.21-0.87;P = .018).
- 轻度或较大的PVL的患病率为23.5%.
结论:
- 与大动脉环相对较窄的LVOT区域与TAVR后PVL风险增加独立相关.
- 这些发现表明,在THV大小中应考虑LVOT尺寸,以潜在地减轻PVL.
- 相对LVOT面积是接受新一代THV的患者PVL的重要预测因素.
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