3-Dimensional Aortic Annular Assessment by Multidetector Computed Tomography Predicts Moderate or Severe Paravalvular Regurgitation After Transcatheter Aortic Valve Replacement A Multicenter Retrospective Analysis

被引：314

作者：

Willson, Alexander B. ^{[1
,2
]}

Webb, John G. ^{[1
,2
]}

LaBounty, Troy M. ^{[3
,4
,5
]}

Achenbach, Stephan ^{[6
]}

Moss, Robert ^{[1
,2
]}

Wheeler, Miriam ^{[1
,2
]}

Thompson, Christopher ^{[1
,2
]}

Min, James K. ^{[3
,4
,5
]}

Gurvitch, Ronen ^{[1
,2
]}

Norgaard, Bjarne L. ^{[7
]}

Hague, Cameron J. ^{[1
,2
]}

Toggweiler, Stefan ^{[1
,2
]}

Binder, Ronald ^{[1
,2
]}

Freeman, Melanie ^{[1
,2
]}

Poulter, Rohan ^{[1
,2
]}

Poulsen, Steen ^{[7
]}

Wood, David A. ^{[1
,2
]}

Leipsic, Jonathon ^{[1
,2
]}

机构：

[1] Univ British Columbia, St Pauls Hosp, Dept Med Imaging, Vancouver, BC V6Z 1Y6, Canada

[2] Univ British Columbia, St Pauls Hosp, Div Cardiol, Vancouver, BC V6Z 1Y6, Canada

[3] Cedars Sinai Med Ctr, Dept Med, Div Cardiol, Los Angeles, CA 90048 USA

[4] Cedars Sinai Med Ctr, Div Cardiol, Dept Imaging, Los Angeles, CA 90048 USA

[5] Cedars Sinai Med Ctr, Div Cardiol, Dept Biomed Sci, Los Angeles, CA 90048 USA

[6] Univ Giessen, Dept Cardiol, Giessen, Germany

[7] Aarhus Univ, Hosp Skejby, Cardiac Imaging Ctr, Dept Cardiol B, Aarhus, Denmark

来源：

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY | 2012年 / 59卷 / 14期

关键词：

aortic annulus; multidetector computed tomography; paravalvular aortic regurgitation; transcatheter aortic valve implantation; transcatheter aortic valve replacement; IMPLANTATION IMPACT; DEPLOYMENT; OUTCOMES; STENOSIS;

D O I：

10.1016/j.jacc.2011.12.015

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Objectives This study sought to analyze multidetector computed tomography (MDCT) 3-dimensional aortic annular dimensions for the prediction of paravalvular aortic regurgitation (PAR) following transcatheter aortic valve replacement (TAVR). Background Moderate or severe PAR after TAVR is associated with increased morbidity and mortality. Methods A total of 109 consecutive patients underwent MDCT pre-TAVR with a balloon expandable aortic valve. Differences between transcatheter heart valve (THV) size and MDCT measures of annular size (mean diameter, area, and circumference) were analyzed concerning prediction of PAR. Patients with THV malposition (n = 7) were excluded. In 50 patients, MDCT was repeated after TAVR to assess THV eccentricity (1 - short diameter/long diameter) and expansion (MDCT measured THV area/nominal THV area). Results Moderate or severe PAR (13 of 102) was associated with THV undersizing (THV diameter - mean diameter = -0.7 +/- 1.4 mm vs. 0.9 +/- 1.8 mm for trivial to mild PAR, p < 0.01). The difference between THV size and MDCT annular size was predictive of PAR (mean diameter: area under the curve [AUC]: 0.81, 95% confidence interval [CI]: 0.68 to 0.88; area: AUC: 0.80, 95% CI: 0.65 to 0.90; circumference: AUC: 0.76, 95% CI: 0.59 to 0.91). Annular eccentricity was not associated with PAR (AUC: 0.58, 95% CI: 0.46 to 0.75). We found that 35.3% (36 of 102) and 45.1% (46 of 102) of THVs were undersized relative to the MDCT mean diameter and area, respectively. THV oversizing relative to the annular area was not associated with THV eccentricity or underexpansion (oversized vs. undersized THVs; expansion: 102.7 +/- 5.3% vs. 106.1 +/- 5.6%, p = 0.03; eccentricity: median: 1.7% [interquartile range: 1.4% to 3.0%] vs. 1.7% [interquartile range: 1.1% to 2.7%], p = 0.28). Conclusions MDCT-derived 3-dimensional aortic annular measurements are predictive of moderate or severe PAR following TAVR. Oversizing of THVs may reduce the risk of moderate or severe PAR. (J Am Coll Cardiol 2012;59:1287-94) (C) 2012 by the American College of Cardiology Foundation

引用

页码：1287 / 1294

页数：8

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