LIRA法指导经导管主动脉瓣置换术治疗主动脉瓣狭窄的可靠性分析

Analysis on the Reliability of Using the LIRA Method to Guide Percutaneous Aortic Valve Replacement for Patients With Severe Aortic Stenosis

目的:分析主动脉瓣狭窄患者经导管主动脉瓣置换术(TAVR)术前脊置入水平(LIRA)平面的周长与术后该平面的支架周长的关系,评估用术前LIRA平面周长预测术后支架周长的方法(LIRA法)指导TAVR的可靠性。方法:回顾性分析2018年2月至2022年11月在南京大学医学院附属鼓楼医院接受TAVR治疗的34例主动脉瓣狭窄患者,分析TAVR前后的CT血管造影(CTA),测量术前LIRA平面周长及术后该平面的支架周长。结果:34例患者的年龄为78.50(73.00,82.25)岁,其中男性18例(52.94%),美国胸外科医师协会(STS)评分为(6.48±0.72)%,二叶式主动脉瓣(BAV)患者10例(29.41%),三叶式主动脉瓣(TAV)患者24例(70.59%)。总体上,术前LIRA平面周长与术后该平面的支架周长差异无统计学意义[(58.69±2.13)mm vs.(61.19±1.04)mm,P=0.157]。TAV患者术前LIRA平面周长比BAV患者更长[(61.88±2.14)mm vs.(51.05±4.40)mm,P=0.018]。TAV患者术后LIRA平面支架周长与BAV患者差异无统计学意义[(61.75±1.04)mm vs.(59.87±2.58)mm,P=0.420]。TAV患者术前LIRA平面周长与术后该平面支架周长差异无统计学意义[(61.88±2.14)mm vs.(61.75±1.04)mm,P=0.938],而BAV患者术前LIRA平面周长小于术后该平面支架周长[(51.05±4.40)mm vs.(59.87±2.58)mm,P=0.039]。TAV患者术前LIRA平面周长与术后该平面支架周长的差值比BAV患者小[(-0.13±1.70)mmvs.(8.82±3.65)mm,P=0.016]。结论:从总体上看,术前LIRA平面周长可以预测术后该平面支架周长。对于中国主动脉瓣狭窄患者,相比于BAV患者,LIRA法可能更适用于TAV患者。LIRA法或为TAVR术中瓣膜选择提供一种新的、安全有效的方法。

Objectives:We analyzed the relationship between the preoperative circumference of the level of implantation at the raphe(LIRA)plane and the postoperative stent circumference in that plane in aortic stenosis(AS)patients treated with transcatheter aortic valve replacement(TAVR),and assessed the reliability of the method of predicting postoperative stent circumference using the preoperative LIRA plane circumference(the LIRA method)for guiding TAVR.Methods:A retrospective analysis was performed on 34 patients with AS treated with TAVR from February 2018 to November 2022 at Nanjing Drum Tower Hospital,the Affiliated Hospital of Nanjing University Medical School.Computed tomography angiography(CTA)was performed before and after the TAVR procedure,and the pre-procedural LIRA plane and the post-procedural stent in this plane were measured.Results:The age of enrolled patients was 78.50(73.00,82.25)years,18 patients(52.94%)were male.The mean Society of Thoracic Surgeons(STS)risk score was(6.48±0.72)%.There were 10 patients(29.41%)with bicuspid aortic valve(BAV)and 24 patients(70.59%)with tricuspid aortic valve(TAV).The pre-procedural LIRA plane circumference was similar to the post-procedural stent circumference in this plane([58.69±2.13]mm vs.[61.19±1.04]mm,P=0.157).Pre-procedural LIRA plane circumference was larger in TAV patients than in BAV patients([61.88±2.14]mm vs.[51.05±4.40]mm,P=0.018).Post-procedural LIRA plane stent circumference was similar between TAV and BAV patients([61.75±1.04]mm vs.[59.87±2.58]mm,P=0.420).Pre-and post-procedural LIRA plane circumference remained unchanged in TAV patients([61.88±2.14]mm vs.[61.75±1.04]mm,P=0.938).However,the post-procedural LIRA plane circumference was significantly greater in patients with BAV compared to pre-procedural level([51.05±4.40]mm vs.[59.87±2.58]mm,P=0.039).The difference in LIRA plane circumference before and after TAVR was smaller in patients with TAV than in patients with BAV([-0.13±1.70]mm vs.[8.82±3.65]mm,P=0.016).Conclusions:The perimeter of the pre-procedural LIRA plane could predict the perimeter of the post-procedural stent.In Chinese AS patients,the LIRA method may be more applicable to TAV patients as compared to BAV patients.Therefore,the LIRA method may be able to provide a new,safe and effective method for transcatheter heart valve sizing in AS patients with TAV.