经导管主动脉瓣置换术植入Venus-A瓣膜后发生瓣周漏的危险因素分析  

Risk factors of perivalvular leakage after transcatheter aortic valve replacement with Venus-A valve

作　　者：王勇 罗小林 张辰 刘婷 曾颖 饶荣生 钱德慧 于世勇 晋军 Wang Yong;Luo Xiaolin;Zhang Chen;Liu Ting;Zeng Ying;Rao Rongsheng;Qian Dehui;Yu Shiyong;Jin Jun(Department of Cardiology,Second Affiliated Hospital of Army Medical University,PLA,Chongqing 400037,China;Department of Ultrasonography,Second Affiliated Hospital of Army Medical University,PLA,Chongqing 400037,China)

机构地区：[1]陆军军医大学第二附属医院心血管内科,重庆400037 [2]陆军军医大学第二附属医院超声科,重庆400037

出　　处：《中华心血管病杂志》2021年第7期694-700,共7页Chinese Journal of Cardiology

基　　金：陆军军医大学临床技术创新培育项目(CX2019LC113);陆军军医大学第二附属医院临床重大创新特色技术项目(2018JSLC0018)。

摘　　要：目的探讨经导管主动脉瓣置换术(TAVR)置入Venus-A瓣膜后发生中/重度瓣周漏(PVL)的危险因素。方法该研究为单中心病例对照研究。纳入2017年10月至2021年1月在陆军军医大学第二附属医院心内科行TAVR治疗且植入Venus-A瓣膜的主动脉瓣重度狭窄患者。依据出院前经胸超声心动图测得的反流束长度与瓣环周长之比(院内死亡患者参考术中瓣膜释放后的经食道超声心动图检查结果),将患者分为中/重度PVL组和轻度/无PVL组。比较两组患者的临床特征、主动脉根部及全主动脉CT扫描与分析结果。采用多因素logistic回归模型筛选术后中/重度PVL的独立危险因素,并使用受试者工作特征(ROC)曲线观察各影响因素对中/重度PVL的预测价值。结果该研究共纳入82例患者,年龄(70.9±6.5)岁,其中男性46例。中/重度PVL组16例,轻度/无PVL组66例。中/重度PVL组的男性占比、瓣膜植入深度、瓣环和左心室流出道(LVOT)长短径、LVOT覆盖指数均大于轻度/无PVL组(P均<0.05)。主动脉成角有大于轻度/无PVL组的趋势,但差异无统计学意义(P=0.051)。因瓣环短径、LVOT长短径及LVOT覆盖指数之间均存在较强的共线性(偏相关系数R 0.251-0.779,P<0.05),未将前二者带入多因素模型。多因素logistic回归分析结果显示,瓣膜植入深度(OR=1.239,95%CI 1.036-1.442,P=0.023)、主动脉成角(OR=1.128,95%CI 1.044-1.312,P=0.038)及LVOT覆盖指数(OR=1.123,95%CI 1.003-1.315,P=0.032)是TAVR术后中/重度PVL的独立危险因素。ROC曲线显示瓣膜植入深度可预测TAVR术后中/重度PVL的发生[曲线下面积(AUC)=0.697,95%CI 0.554-0.851,P=0.039],而LVOT覆盖指数(AUC=0.683,95%CI 0.512-0.853,P=0.056)及主动脉成角(AUC=0.590,95%CI 0.397-0.783,P=0.346)的预测价值有待进一步验证。结论行TAVR植入Venus-A自膨胀瓣膜的主动脉瓣重度狭窄患者,瓣膜植入深度、主动脉成角及LVOT覆盖指数是其术后中/重度PVL的独立危险因素,�Objective To investigate the risk factors of moderate or severe perivalvular leakage(PVL)after transcatheter aortic valve replacement(TAVR)with Veneus-A valve.Methods This study was a single-center case-control study.The clinical data of patients with severe aortic stenosis,who underwent TAVR in the Department of Cardiology of Second Affiliated Hospital of Army Medical University from October 2017 to January 2021,were analyzed.According to the circumferential extent of prosthetic valve paravalvular regurgitation measured by transthoracic echocardiography before discharge(patients who died in hospital were referred to transesophageal echocardiography results after valve implanted),the patients were divided into moderate or severe PVL group and mild or non-PVL group.The clinical features,CT scan and analysis results of aortic root were compared between the two groups.Multivariate logistic regression analysis was used to identify the independent risk factors of postoperative moderate or severe PVL,and receiver operating characteristic(ROC)curve was used to explore the predictive value of related factors.Results Eighty-two patients(mean age:(70.9±6.5)years,46 males)were included in the analysis,there were 16 patients in the moderate or severe PVL group and 66 patients in the mild or non-PVL group.The proportion of male gender,depth of valve implantation,size of valve annulus and left ventricular outflow tract(LVOT),and coverage index of LVOT were significantly higher in moderate or severe PVL group than those in mild or non-PVL group(P all<0.05).As there was a strong collinearity among the valve annular short diameter,LVOT short diameter and LVOT coverage index(partial correlation coefficient R 0.251-0.779,P<0.05),these parameters were not entered in regression model.Multivariate logistic regression analysis showed that valve implantation depth(OR=1.239,95%CI 1.036-1.442,P=0.023),aortic angulation(OR=1.128,95%CI 1.044-1.312,P=0.038)and LVOT tract coverage index(OR=1.123,95%CI 1.003-1.315,P=0.032)were independent ris

关 键 词：主动脉瓣狭窄 经导管主动脉瓣置换术 瓣周漏 

分 类 号：R654.2[医药卫生—外科学]