- 作者：Jan-Malte Sinning ; MD ; Christoph Hammerstingl ; MD ; Mariuca Vasa-Nicotera ; MD ; Viktoria Adenauer ; MD ; Sisa Josefina Lema Cachiguango ; MD ; Anne-Cathé ; rine Scheer ; MD ; Sven Hausen ; MD ; Alexander Sedaghat ; MD ; Alexander Ghanem ; MD ; Cornelius Mü ; ller ; MD ; Eberhard Grube ; MD ; Georg Nickenig ; MD ; georg.nickenig@ukb.uni-bonn.de ; Nikos Werner ; MD
- 关键词：AR index ; CoreValve ; paravalvular leak ; peri-prosthetic regurgitation ; TAVI
- 刊名：Journal of the American College of Cardiology
- 出版年：2012
- 出版时间：27 March, 2012
- 年：2012
- 卷：59
- 期：13
- 页码：1134-1141
- 全文大小：1195 K
Objectives
The aim of this study was to provide a simple, reproducible, and point-of-care assessment of peri-prosthetic aortic regurgitation (periAR) during transcatheter aortic valve implantation (TAVI) and to decipher the impact of this peri-procedural parameter on outcome.Background
Because periAR after TAVI might be associated with adverse outcome, precise quantification of periAR is of paramount importance but remains technically challenging.
Methods
The severity of periAR was prospectively evaluated in 146 patients treated with the Medtronic CoreValve (Minneapolis, Minnesota) prosthesis by echocardiography, angiography, and measurement of the aortic regurgitation (AR) index, which is calculated as ratio of the gradient between diastolic blood pressure (DBP) and left ventricular end-diastolic pressure (LVEDP) to systolic blood pressure (SBP): [(DBP ?LVEDP)/SBP] ¡Á 100.
Results
After TAVI, 53 patients (36.3 % ) showed no signs of periAR and 71 patients (48.6 % ) showed only mild periAR, whereas 18 patients (12.3 % ) and 4 patients (2.7 % ) suffered from moderate and severe periAR, respectively. The AR index decreased stepwise from 31.7 ¡À 10.4 in patients without periAR, to 28.0 ¡À 8.5 with mild periAR, 19.6 ¡À 7.6 with moderate periAR, and 7.6 ¡À 2.6 with severe periAR (p < 0.001), respectively. Patients with AR index <25 had a significantly increased 1-year mortality risk compared with patients with AR index ?5 (46.0 % vs. 16.7 % ; p < 0.001). The AR index provided additional prognostic information beyond the echocardiographically assessed severity of periAR and independently predicted 1-year mortality (hazard ratio: 2.9, 95 % confidence interval: 1.3 to 6.4; p = 0.009).
Conclusions
The assessment of the AR index allows a precise judgment of periAR, independently predicts 1-year mortality after TAVI, and provides additional prognostic information that is complementary to the echocardiographically assessed severity of periAR.