主动脉瓣二叶畸形经导管主动脉瓣置换术后瓣周漏的危险因素研究  

Research in Risk Factors of Perivalvular Leakage After Transcatheter Aortic Valve Replacement in Bicuspid Aortic Valve

作　　者：徐磊 吕冬琴 曾子凌 黄良焰 赖晓玥 夏红梅 Xu Lei;Lyu Dongqin;Zeng Ziling;Huang Liangyan;Lai Xiaoyue;Xia Hongmei(Department of Ultrsound,The Second Affiliated Hospital of Army Medical University,PLA,Chongqing 400037,China;The First School of Clinical Medicine,Southern Medical University,Guangzhou 510515,China)

机构地区：[1]陆军军医大学第二附属医院超声科,重庆市400037 [2]南方医科大学第一临床医学院,广州市510515

出　　处：《中国超声医学杂志》2023年第1期26-29,共4页Chinese Journal of Ultrasound in Medicine

摘　　要：目的 应用超声心动图评价主动脉瓣二叶畸形经导管主动脉瓣置换术(TAVR)后发生瓣周漏(PVL)的危险因素。方法 回顾性分析TAVR手术患者共计363例,先天性主动脉瓣二叶畸形(BAV)60例,正常三叶式主动脉瓣(TAV)303例。瓣叶类型为分组变量,原始队列以1∶1倾向性评分匹配法(PSM)筛选出PSM队列。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,使用受试者工作特征(ROC)曲线观察超声相关危险因素对术后中重度PVL的预测价值。结果 (1)筛选出57对PSM队列组间基线数据无统计学意义(P>0.05),两组间术后发生轻度PVL比例无统计学意义(P>0.05),但BAV组术后发生中重度PVL的比例高于TAV组(P=0.026)。(2)57对PSM队列多因素Logistic回归分析显示,瓣叶类型(BAV)(OR=6.103,95%CI:1.206~30.872,P=0.029)、术前左室流出道(LVOT)形态指数(OR=0.896,95%CI:0.817~0.982,P=0.019)与术后发生中重度PVL存在独立相关。(3)ROC曲线显示LVOT形态指数可预测BAV组术后中重度PVL的发生[曲线下面积(AUC)=0.744,95%CI:0.602~0.886,P=0.021]。结论 TAVR术后BAV比TAV患者更易发生中重度PVL。LVOT形态指数是所有患者TAVR术后发生中重度PVL的独立危险因素,但仅对BAV具有一定预测价值。Objective To study the risk factors of perivalvular leakage(PVL) after transcatheter aortic valve replacement(TAVR) by echocardiography during perioperative period.Methods A total of 363 patients were retrospectively analyzed,including 60 patients with congenital bicuspid aortic valve(BAV) and 303 patients with tricuspid aortic valve(TAV).The original cohort was screened by 1∶1 propensity score matching(PSM)method to obtain the PSM cohort.Multivariate logistic regression model was used to screen the independent risk factors for moderate-to-severe PVL,and the receiver operating characteristic curve was used to observe the predictive value of echocardiography-related risk factors for moderate-to-severe PVL.Results After propensity score matching,57 pairs of matching cohorts were selected and the baseline data of the 2 groups were balanced(P>0.05).The proportion of mild PVL in BAV group was not different from that in TAV group in statistic,but the proportion of moderate-to-severe PVL in BAV group was higher than that in TAV group significantly(P=0.026).Multivariate logistic regression analysis of PSM cohort showed that BAV(OR=6.103,95%CI:1.206-30.872,P=0.029) and Left ventricular outflow tract(LVOT) shape index(OR=0.896,95%CI:0.817-0.982,P=0.019) were positively correlated with moderate-to-severe PVL.The receiver operating characteristic curve showed that the LVOT shape index could predict the occurrence of moderate-to-severe PVL after TAVR in BAV patients [Area under curve(AUC)=0.744,95%CI:0.602-0.886,P=0.021].Conclusions Compared with the TAV patients,BAV patients are more likely to develop moderate-to-severe PVL after TAVR.LVOT shape index is an independent risk factor for moderate-to-severe PVL after TAVR in BAV and TAV patients,and it could be only used to predict the occurrence of moderate-to-severe PVL in BAV patients.

关 键 词：超声心动描记术 经导管主动脉瓣置换术 二叶式主动脉瓣 瓣周漏 

分 类 号：R540.45[医药卫生—心血管疾病] R654.2[医药卫生—内科学]