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Impact of Predilatation Prior to Transcatheter Aortic Valve Implantation With the Self-Expanding Acurate neo Device (from the Multicenter NEOPRO Registry).

自膨式Acurate neo装置 (来自多中心NEOPRO注册中心) 在经导管主动脉瓣植入术前预扩张的影响。

  • 影响因子:2.86
  • DOI:10.1016/j.amjcard.2020.02.003
  • 作者列表:"Pagnesi M","Kim WK","Conradi L","Barbanti M","Stefanini GG","Schofer J","Hildick-Smith D","Pilgrim T","Abizaid A","Zweiker D","Testa L","Taramasso M","Wolf A","Webb JG","Sedaghat A","Van der Heyden JAS","Ziviello F","MacCarthy P","Hamm CW","Bhadra OD","Schäfer U","Costa G","Tamburino C","Cannata F","Reimers B","Eitan A","Alsanjari O","Asami M","Windecker S","Siqueira D","Schmidt A","Bianchi G","Bedogni F","Saccocci M","Maisano F","Jensen CJ","Naber CK","Alenezi A","Wood DA","Sinning JM","Brouwer J","Tzalamouras V","Van Mieghem NM","Colombo A","Latib A
  • 发表时间:2020-05-01
Abstract

:Safety and feasibility of transfemoral Acurate neo implantation without systematic predilatation are not fully investigated. Our aim was to evaluate the use and impact of pre-implantation balloon aortic valvuloplasty (pre-BAV) before transcatheter aortic valve implantation (TAVI) with Acurate neo. The NEOPRO Registry retrospectively included 1,263 patients who underwent transfemoral TAVI with Acurate neo at 18 centers between January 2012 and March 2018. Information on pre-BAV was available for 1,262 patients (99.9%). Primary end points were pre-discharge moderate-to-severe paravalvular aortic regurgitation (PAR II+), 30-day new permanent pacemaker implantation, and 30-day all-cause mortality or stroke. A total of 1,262 patients who underwent TAVI with (n = 1,051) or without predilatation (n = 211) were included. A reduction in the pre-BAV rate was observed during the study period (from 95.7% in the first date quintile to 78.4% in the last date quintile). Patients who underwent pre-BAV had higher degrees of aortic valve (AV) and left ventricular outflow tract (LVOT) calcification. Primary endpoints were similar between pre-BAV and no pre-BAV groups (PAR II+ 5.5% vs 3.4%, p = 0.214; 30-day permanent pacemaker implantation 9.0% vs 8.0%, p = 0.660; 30-day death or stroke 4.9% vs 4.4%, p = 0.743). The need for postdilatation and other procedural outcomes were comparable between groups. Predilatation did not have a significant impact on primary endpoints across AV and LVOT calcification subgroups (subgroup analyses) and was not independently associated with primary endpoints (multivariate analyses). In conclusion, transfemoral Acurate neo implantation without predilatation appears to be feasible and safe, especially in patients with milder degrees of AV and LVOT calcification.

摘要

: 没有系统预扩张的经股Acurate新植入的安全性和可行性尚未得到充分研究。我们的目的是评估植入前球囊主动脉瓣成形术 (pre-BAV) 在经导管主动脉瓣植入术 (TAVI) 和Acurate neo之前的使用和影响。NEOPRO注册研究回顾性纳入了2012年1月至2018年3月期间在18个中心接受了Acurate neo的1,263例患者。1,262例患者 (99.9%) 获得了关于前BAV的信息。主要终点为出院前中重度主动脉瓣旁反流 (PAR II +),30天新永久起搏器植入,30天全因死亡率或卒中.共纳入1,262例接受TAVI伴 (n   = 1,051) 或不伴预扩张 (n   = 211) 的患者。在研究期间观察到BAV前率的降低 (从第一个日期的95.7% 至最后一个日期的78.4%)。接受BAV前的患者主动脉瓣 (AV) 和左心室流出道 (LVOT) 钙化程度较高。主要终点是类似前二瓣化畸形并没有预先二瓣化畸形 (PAR II + 5.5% vs 3.4%,p  =   0.214; 30天永久性心脏起搏器植入术9.0% vs 8.0%,p  =   0.660; 30天死亡及4.9% vs 4.4%,p  =   0.743).在两组之间,对术后和其他手术结局的需求是相当的.预扩张对AV和LVOT钙化亚组的主要终点无显著影响 (亚组分析),且与主要终点无独立相关性 (多变量分析).总之,无预扩张的经股Acurate新植入似乎是可行和安全的,特别是在AV和LVOT钙化程度较轻的患者中。

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心脏瓣膜病方向

人的心脏有四个瓣膜,分别为二尖瓣、三尖瓣、主动脉瓣和肺动脉瓣。心脏瓣膜病就是指二尖瓣、三尖瓣、主动脉瓣和肺动脉瓣的瓣膜因风湿热、黏液变性、退行性改变、先天性畸形、缺血性坏死、感染或创伤等出现了病变,影响血流的正常流动,从而造成心脏功能异常,最终导致心力衰竭的单瓣膜或多瓣膜病变。随着人口老龄化加重,老年性瓣膜病以及冠心病、心肌梗死后引起的瓣膜病变也越来越常见。

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