经导管主动脉瓣置换术前CT解剖特征与风险分类——多中心前瞻性横断面研究  

Preoperative CT Anatomic Characteristics and Risk Classification of Transcatheter Aortic Valve Replacement:a Multicenter Prospective Cross-sectional Study

作　　者：陈阳[1,2] 王墨扬 牛冠男[1] 赵杰[1] 张洪亮[1] 刘庆荣[1] 赵振燕[1] 随永刚[1] 丰德京[1] 张斌 李子昂[1] 胡祥铭 张宇轩 王璨 曾正 吕滨 武涛[4] 宋光远 吴永健 CHEN Yang;WANG Moyang;NIU Guannan;ZHAO Jie;ZHANG Hongliang;LIU Qingrong;ZHAO Zhenyan;SUI Yonggang;FENG Dejing;ZHANG Bin;LI Ziang;HU Xiangming;ZHANG Yuxuan;WANG Can;ZENG Zheng;LYU Bin;WU Tao;SONG Guangyuan;WU Yongjian(Coronary Heart Disease Center,National Center for Cardiovascular Diseases and Fuwai Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100037,China;Department of Cardiology,Peking University People's Hospital,Beijing 100044,China;Department of Radiology,National Center for Cardiovascular Diseases and Fuwai Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100037,China;Lepu Medical Technology(Beijing)Co.,Ltd,National Heart Transplantation Interventional Diagnosis and Treatment Equipment and Equipment Engineering Technology Research Center,Beijing 102299,China;Department of Interventional Center of Valvular Heart Disease,Beijing Anzhen Hospital,Capital Medical University,Beijing 100011,China)

机构地区：[1]中国医学科学院北京协和医学院国家心血管病中心阜外医院冠心病中心,北京100037 [2]北京大学人民医院心内科,北京100044 [3]中国医学科学院北京协和医学院国家心血管病中心阜外医院放射影像科,北京100037 [4]乐普(北京)医疗器械股份有限公司国家心脏病植介入诊疗器械及设备工程技术研究中心,北京102299 [5]首都医科大学附属北京安贞医院心脏瓣膜病介入中心,北京100011

出　　处：《中国循环杂志》2023年第10期1042-1049,共8页Chinese Circulation Journal

基　　金：国家重点研发计划(2020YFC2008103);中国医学科学院医学与健康科技创新工程(2021-I2M-C&T-A-010);首都卫生发展科研专项项目(2020-1-4031)。

摘　　要：目的:CT测量对于经导管主动脉瓣置换术(TAVR)患者术前风险评估不可或缺,然而当前国内外缺少TAVR术前CT解剖风险评估分类,本研究将初步就此进行总结。方法:多中心前瞻性收集2021年9月至2022年9月就诊的症状性重度主动脉瓣病变患者210例,收集并分析患者基线信息、CT测量及解剖风险和解剖风险分类。TAVR术前主动脉瓣病变的CT解剖综合风险分为A类(简单病变)、B类(复杂病变)、C类(高危复杂病变)、D类(禁忌病变)四类。结果:210例患者平均年龄(73.1±5.5)岁,男性89例(42.4%),左心室射血分数为(55.0±13.8)%。瓣叶分型包括70例(33.3%)三叶瓣,47例(22.4%)0型二叶瓣,82例(39.1%)1型二叶瓣和11例(5.2%)2型二叶瓣。其中常见解剖风险包括冠状动脉闭塞风险(38.6%),横位心(22.4%),下肢入路风险(21.4%),重度钙化(20.0%),瓣叶钙化不足(14.8%),小心室(12.9%),升主动脉扩张(12.4%)和瓣环破裂风险(10.5%)。综合风险分类结果为,31例A类(14.8%),131例B类(62.4%),36例C类(17.1%),12例D类(5.7%)。结论:不同瓣叶分型的TAVR术前CT解剖特征及病变风险分类有所差异,术前CT识别TAVR的高危复杂病变和禁忌病变十分重要。Objectives:CT measurement is indispensable for preoperative risk assessment for patients with indication for transcatheter aortic valve replacement(TAVR),however,there is currently a lack of classification for preoperative CT anatomical risk assessment of TAVR both domestically and internationally.This study preliminarily summarized the CT measurement characteristics and risk classification among patients screened for TAVR.Methods:210 patients with symptomatic severe aortic valve disease were prospectively collected in multiple Chineses centers from September 2021 to September 2022.The baseline information,CT measurement,anatomic risk and risk classification of patients were collected and analyzed.The CT anatomic comprehensive risk classification of TAVR is divided into Class A(simple lesions),Class B(complex lesions),Class C(high-risk complex lesions),and Class D(contraindicated lesions).Results:The mean age of 210 patients was(73.1±5.5)years old,89(42.4%)were male,and the left ventricular ejection fraction was(55.0±13.8)%.The classification of aortic valve included 70 cases(33.3%)of tricuspid valve,47 cases(22.4%)of type 0 bicuspid valve,82 cases(39.1%)of type 1 bicuspid valve,and 11 cases(5.2%)of type 2 bicuspid valve.Common anatomic risks include Common anatomic risks include coronary artery occlusion risk(38.6%),transverse heart(22.4%),lower limb approach risk(21.4%),severe calcification(20.0%),no calcification(14.8%),caution chamber(12.9%),ascending aorta dilation(12.4%),and annulus rupture risk(10.5%).Comprehensive lesion risk classification was as follows:31 cases(14.8%)with Class A risk,131 cases(62.4%)with Class B risk,36 cases(17.1%)with Class C risk,and 12 cases(5.7%)with Class D risk.Conclusions:This multicenter prospective cohort study shows that the preoperative CT anatomic characteristics and risk classification of TAVR with different valve classification are different.It is important to identify high-risk complex lesions and contraindications for screened TAVR patients by preoperative CT.

关 键 词：主动脉瓣狭窄 经导管主动脉瓣置换术 CT解剖特征 风险分类 

分 类 号：R54[医药卫生—心血管疾病]