Outcomes With Post-Dilation Following Transcatheter Aortic Valve Replacement

被引：86

作者：

Hahn, Rebecca T. ^{[1
]}

Pibarot, Philippe ^{[2
]}

Webb, John ^{[3
,4
]}

Rodes-Cabau, Josep ^{[2
]}

Herrmann, Howard C. ^{[5
]}

Williams, Mathew ^{[1
]}

Makkar, Raj ^{[6
]}

Szeto, Wilson Y. ^{[5
]}

Main, Michael L. ^{[7
]}

Thourani, Vinod H. ^{[8
]}

Tuzcu, E. Murat ^{[9
]}

Kapadia, Samir ^{[9
]}

Akin, Jodi ^{[10
]}

McAndrew, Thomas ^{[11
]}

Xu, Ke ^{[11
]}

Leon, Martin B. ^{[1
]}

Kodali, Susheel K. ^{[1
]}

机构：

[1] Columbia Univ, New York Presbyterian Hosp, Med Ctr, New York, NY 10032 USA

[2] Univ Laval, Dept Med, Quebec City, PQ G1K 7P4, Canada

[3] Univ British Columbia, Vancouver, BC V5Z 1M9, Canada

[4] St Pauls Hosp, Vancouver, BC V6Z 1Y6, Canada

[5] Hosp Univ Penn, Philadelphia, PA 19104 USA

[6] Cedars Sinai Med Ctr, Los Angeles, CA 90048 USA

[7] St Lukes Mid Amer Heart Inst, Kansas City, MO USA

[8] Emory Univ, Sch Med, Atlanta, GA USA

[9] Cleveland Clin Fdn, Cleveland, OH 44195 USA

[10] Edwards Lifesci, Irvine, CA USA

[11] Cardiovasc Res Fdn, New York, NY USA

来源：

JACC-CARDIOVASCULAR INTERVENTIONS | 2014年 / 7卷 / 07期

关键词：

aortic stenosis; paravalvular regurgitation; post-dilation; prosthesis-patient mismatch; reballooning; transcatheter aortic valve replacement; 3-DIMENSIONAL TRANSESOPHAGEAL ECHOCARDIOGRAPHY; PARAVALVULAR REGURGITATION; STANDARDS COMMITTEE; COMPUTED-TOMOGRAPHY; AMERICAN-SOCIETY; COREVALVE IMPLANTATION; EUROPEAN-ASSOCIATION; PREDICTIVE FACTORS; TASK-FORCE; RECOMMENDATIONS;

D O I：

10.1016/j.jcin.2014.02.013

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Objectives This study sought to characterize the patients receiving post-implantation balloon dilation (PD) following transcatheter aortic valve replacement (TAVR) and evaluate procedural outcomes in the PARTNER (Placement of Aortic Transcatheter Valve) I trial. Background Following TAVR, PD has been used to treat paravalvular regurgitation. Methods The PARTNER I trial cohort A (n = 304) and cohort B (n = 194) patients randomized to TAVR and the nonrandomized continued access TAVR (n = 1,637) patients were included in the analysis. PD was performed at the discretion of the operator. Clinical events and echocardiographic variables were collected prospectively out to 1 year. Results The overall incidence of PD was 12.4%. PD patients had significantly less prosthesis-patient mismatch (p < 0.001) and larger effective orifice areas (p < 0.001) throughout the follow-up period. There were significantly more subacute strokes (occurring <7 days: 4.9% vs. 2.6%; p = 0.04) in PD patients but no difference in late stroke, either at 7 to 30 days (0.0% vs. 0.8%; p = 0.16) or >30 days (1.9 vs. 1.7%; p = 0.75). Although there was no significant increase in early mortality with PD, at 1 year, there was a trend for higher all-cause mortality (p = 0.054) and a significant difference in death or stroke (p = 0.04). When the subgroup of patients with none/trace paravalvular regurgitation were evaluated, there was no significant association of PD with mortality (p = 0.61) and death or stroke (p = 0.96). Multivariable analysis failed to show a relationship between PD and mortality. Conclusions PD is associated with reduced rates of moderate or severe prosthesis-patient mismatch with no evidence for short-term structural deterioration of the balloon-expandable transcatheter valve. Although PD is associated with a greater incidence of early stroke, there is no significant association between PD and stroke beyond 7 days. Multivariable analysis shows no significant association between PD and mortality. (J Am Coll Cardiol Intv 2014; 7: 781-9) (C) 2014 by the American College of Cardiology Foundation

引用

页码：781 / 789

页数：9

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