经导管主动脉瓣置换术后一年人工瓣膜影像学形态特点及其对临床的影响

CT Imaging Evaluation Results of Venus-A Valve Prosthesis in Patients at 1 Year Post Transcatheter Aortic Valve Replacement:Impact on Clinical and Hemodynamic Outcomes

目的:分析经导管主动脉瓣置换术(TAVR)后1年人工瓣膜影像学形态特点及其对临床的影响。方法:连续纳入2012-09至2014-12在中国医学科学院阜外医院使用Venus-A主动脉瓣膜行TAVR并完成1年计算机断层摄影术(CT)随访的30例患者。通过术后CT多水平测量人工瓣膜椭圆率、膨胀率、瓣膜置入深度和瓣叶增厚情况等指标,分析人工瓣膜形态特点,以及其结果对术后血流动力学和临床的影响。结果:30例患者Venus-A主动脉瓣膜功能水平(B平面)膨胀率(面积法)良好,为(106.7±17.2)%。二叶式主动脉瓣患者术后B平面膨胀率(面积法)与三叶式主动脉瓣患者比较差异均无统计学意义[(116.9±17.7)%vs(103.6±1.5)%,P=0.132]。B平面膨胀率(面积法)≥100%者(n=23)与B平面膨胀率(面积法)<100%者(n=7)比较,术前CT主动脉根部径线、钙化体积、术中是否球囊后扩张、术后1年CT检测的瓣膜置入深度、人工瓣叶增厚比例、术后1年超声心动图检测的中度及以上瓣周反流的比例、左心室射血分数以及纽约心脏协会(NYHA)心功能≥Ⅲ级患者比例的差异均无统计学意义(P>0.05);与B平面膨胀率(面积法)<100%者相比,B平面膨胀率(面积法)≥100%者术后1年超声心动图检测最大跨瓣流速更低[(2.1±0.4)m/s vs(2.6±0.5)m/s,P=0.023]。结论 :置入Venus-A主动脉瓣膜后1年CT评估人工瓣膜功能水平完全膨胀程度较高,血流动力学总体结果满意。

Objectives：This study sought to characterize the computed tomography（CT） imaging results of Venus-A valve prosthesis at 1 year post transcatheter aortic valve replacement（TAVR） due to severe aortic stenosis and explore the impact on hemodynamic and clinical outcomes.Methods： A total of 30 consecutive patients, who underwent TAVR using Venus-A valve at Fuwai hospital from 2012-9 to 2014-12 and finished 1-year CT evaluation, were included in this study. One-year CT data including the eccentricity index, expansion rate at different levels of the prosthesis, the implantation depth and leaflet thickening were retrospectively analyzed. We further assessed their impact on post-procedural hemodynamic and clinical outcomes. Results： The expansion rate（by area） of the Venus-A prosthesis was significantly higher at functional level（B plane）（[106.7±17.2]）% than that at inflow level（A plane）（[84.1±20.6]%, P〈0.05） and outflow level（C plane）[（86.0±15.3）%,P 0.05）]. B plane expansion rate（[116.9±17.7]% vs [103.6±1.5]%, P =0.132） and the eccentricity index of the sinus level（B＇plane）（[12.3±4.3]% vs [17.9±8.5]%, P =0.118） were similar between patients with bicuspid and tricuspid aortic valves. Sufficient stent expansion（B plane expansion rate by area≥100%） were achieved in 23 cases（76.7%）. There wasno significant difference in preoperative sinus mean diameter, calcification volume, implantation depth and post balloon dilatation between patients with insufficient expansion（B plane expansion rate 100% by area） and sufficient expansion（P〈0.05）.The aortic valve maximum velocity at 1 year was significantly higher in insufficient expansion patients than those patients with sufficient expansion（[2.6±0.5]m/s vs [2.1±0.4]m/s, P=0.023）. There was no significant difference in the prosthesis leaflet thickening, paravalvular leak, left ventricular ejection fraction and improvement of NYHA class at 1-year follow-up between patients with insufficient or sufficient expansion（P〉0.05）. Conclusions： CT imaging evidenced high frequency of sufficient expansion in Venus-A valve and satisfied hemodynamic outcomes among post-TAVR patients at 1-year post TAVR, which is associated with satisfactory clinical follow-up results.