- 作者：Luis Nombela-Franco ; MD ; Josep Rodé ; s-Cabau ; MD ; josep.rodes@criucpq.ulaval.ca ; Robert DeLarochelliè ; re ; MD ; Eric Larose ; MD ; Daniel Doyle ; MD ; Jacques Villeneuve ; MD ; Sé ; bastien Bergeron ; MD ; Mathieu Bernier ; MD ; Ignacio J. Amat-Santos ; MD ; Michael Mok ; MD ; Marina Urena ; MD ; Michel Rheault ; MD ; Jean Dumesnil ; MD ; Mé ; lanie Cô ; té ; MSc ; Philippe Pibarot ; PhD ; Eric Dumont ; MD
- 关键词：balloon post-dilation ; stroke ; transapical ; transcatheter aortic valve implantation ; transcatheter aortic valve replacement ; transfemoral
- 刊名：JACC ; Cardiovascular Interventions
- 出版年：2012
- 期刊代码：pca198_19368798
- 类别：med
- 出版时间：May, 2012
- 卷：5
- 期：5
- 页码：499-512
- 文件大小：2423 K
Objectives
This study sought to evaluate the predictive factors, effects, and safety of balloon post-dilation (BPD) for the treatment of significant paravalvular aortic regurgitation (AR) after transcatheter aortic valve implantation (TAVI).Background
Very few data exist on BPD after TAVI with a balloon-expandable valve.
Methods
A total of 211 patients who underwent TAVI with a balloon-expandable valve were included. BPD was performed after TAVI if paravalvular AR 鈮? was identified by transesophageal echocardiography. Clinical events and echocardiographic data were prospectively recorded, and median follow-up was 12 (6 to 24) months.
Results
BPD was performed in 59 patients (28%), leading to a reduction in at least 1 degree of AR in 71%of patients, with residual AR <2 in 54%of the patients. The predictors of the need for BPD were the degree of valve calcification and transfemoral approach, with valve calcification volume >2,200 and >3,800 mm3 best determining the need for and a poor response to BPD, respectively. Patients who underwent BPD had a higher incidence of cerebrovascular events at 30 days (11.9%vs. 2.0%, p = 0.006), with most (83%) events within the 24 h after the procedure occurring in patients who had BPD. No significant changes in valve area or AR degree were observed at follow-up in BPD and no-BPD groups.
Conclusions
BPD was needed in about one-fourth of the patients undergoing TAVI with a balloon-expandable valve and was successful in about one-half of them. A higher degree of valve calcification and transfemoral approach predicted the need for BPD. BPD was not associated with any deleterious effect on valve function at mid-term follow-up, but a higher rate of cerebrovascular events was observed in patients who had BPD.