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IF 3.8 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Clinical Research in Cardiology Pub Date : 2024-09-19 DOI:10.1007/s00392-024-02545-9

Yuheng Jia, Arif A. Khokhar, Thomas Pilgrim, Giuliano Costa, Darren Mylotte, Sofia Sammartino, Daijiro Tomii, Emil Fosbøl, Corrado Tamburino, Klaus Fuglsang Kofoed, Marco Barbanti, Stephan Windecker, Mao Chen, Ole De Backer

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引用次数: 0

摘要

背景因二尖瓣主动脉瓣狭窄（AS）而接受经导管主动脉瓣植入术（TAVI）的患者经常会出现升主动脉（AAo）扩张，但未得到及时治疗。本研究的目的是研究二尖瓣主动脉瓣狭窄 TAVI 术后 AAo 扩张的自然进展和潜在机制。方法纳入原发性二尖瓣主动脉瓣狭窄患者，基线 AAo 最大直径为 40 毫米，经 TAVI 术治疗，TAVI 术后 CT 扫描结果超过 1 年。AAo扩张被认为是持续的（增加≥2毫米）或稳定的（增加或减少< 2毫米）。结果共评估了 61 例患者，基线时平均 AAo 最大直径为 45.6 ± 3.9 mm。中位随访 2.9 年，85% 的患者 AAo 尺寸保持稳定。15%的患者的 AAo 持续扩张，扩张速度为每年 1.4 毫米。与 AAo 持续扩张相关的因素有剑突长度/瓣环平均直径比（OR 4.09，95%CI [1.40-16.7]，p = 0.022）、瓣叶流出水平的 TAV 偏心率（OR 2.11，95%CI [1.12-4.53]，p = 0.022）。结论大多数接受 TAVI 治疗双尖瓣 AS 的患者主动脉扩张情况保持稳定。影响TAV支架框架几何形状和功能的因素被认为与TAVI术后AAo持续扩张有关；这一点应在未来更大规模的队列研究中得到证实。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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Incidence and predictors of continued ascending aortic dilatation after TAVI in patients with bicuspid aortic stenosis

Background

Patients undergoing transcatheter aortic valve implantation (TAVI) for bicuspid aortic stenosis (AS) frequently present with ascending aortic (AAo) dilatation which is left untreated. The objective of this study was to study the natural progression and underlying mechanisms of AAo dilatation after TAVI for bicuspid AS.

Methods

Patients with a native bicuspid AS and a baseline AAo maximum diameter > 40 mm treated by TAVI and in whom post-TAVI computed tomography (CT) scans beyond 1 year were available were included. AAo dilatation was deemed to be either continuous (≥ 2 mm increase) or stable (< 2 mm increase or decrease). Uni- and multivariate logistic regression analysis was utilized in order to identify factors associated with continuous AAo dilatation post-TAVI.

Results

A total of 61 patients with a mean AAo maximum diameter of 45.6 ± 3.9 mm at baseline were evaluated. At a median follow-up of 2.9 years, AAo dimensions remained stable in 85% of patients. Continuous AAo dilatation was observed in 15% of patients at a rate of 1.4 mm/year. Factors associated with continuous AAo dilatation were raphe length/annulus mean diameter ratio (OR 4.09, 95% CI [1.40–16.7], p = 0.022), TAV eccentricity at the leaflet outflow level (OR 2.11, 95%CI [1.12–4.53], p = 0.031) and maximum transprosthetic gradient (OR 1.30, 95%CI [0.99–1.73], p = 0.058).

Conclusions

Ascending aortic dilatation in patients undergoing TAVI for bicuspid AS remains stable in the majority of patients. Factors influencing TAV stent frame geometry and function were identified to be associated with continuous AAo dilatation after TAVI; this should be confirmed in future larger cohort studies.

Graphical Abstract

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来源期刊

Clinical Research in Cardiology 医学-心血管系统

CiteScore

11.40

自引率

4.00%

发文量

140

审稿时长

4-8 weeks

期刊介绍： Clinical Research in Cardiology is an international journal for clinical cardiovascular research. It provides a forum for original and review articles as well as critical perspective articles. Articles are only accepted if they meet stringent scientific standards and have undergone peer review. The journal regularly receives articles from the field of clinical cardiology, angiology, as well as heart and vascular surgery. As the official journal of the German Cardiac Society, it gives a current and competent survey on the diagnosis and therapy of heart and vascular diseases.