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英文誌(2004-)

Journal of Medical Ultrasonics

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2016 - Vol.43

Vol.43 No.Supplement

特別プログラム 循環器
パネルディスカッション 循環器 Joint(JSUM・AFSUMB Joint Session)(English) Structural Heart Disease(SHD)のカテーテル治療における 心エコーの役割

(S286)

経カテーテル的大動脈弁留置術における人工弁-患者不適合のリスク評価

Geometric changes in ventriculoaortic complex after TAVI and its association with post-procedural prosthesis-patient mismatch

宇都宮 裕人1, 三原 裕嗣2, 板橋 裕史2, 小林 さゆき2, SIEGEL Robert2, CHAKRAVARTY Tarun2, JILAIHAWI Hasan2, MAKKAR Raj2, 塩田 隆弘2

Hiroto UTSUNOMIYA1, Hirotsugu MIHARA2, Yuji ITABASHI2, Sayuki KOBAYASHI2, Robert SIEGEL2, Tarun CHAKRAVARTY2, Hasan JILAIHAWI2, Raj MAKKAR2, Takahiro SHIOTA2

1シーダーズ・サイナイ病院/広島大学病院循環器内科, 2シーダーズ・サイナイ病院循環器内科

1Division of Cardiology, Cedars-Sinai Medical Center / Hiroshima University Hospital, 2Division of Cardiology, Cedars-Sinai Medical Center

キーワード :

【Aims】
Prosthesis-patient mismatch(PPM)after transcatheter aortic valve implantation(TAVI)leads to increased mortality. However, its peri-procedural determinants remain unknown. We investigated geometric changes in aortic annulus(AoA)and left ventricular outflow tract(LVOT)during TAVI by three-dimensional transesophageal echocardiography(3D-TEE)and its association with post-procedural PPM.
【Methods】
A total of 131 patients with severe aortic stenosis underwent intraprocedural 3D-TEE during balloon-expandable TAVI. The severity of PPM was graded using the indexed effective orifice area calculated by Doppler echocardiography at discharge, with moderate defined as≥0.65 and≤0.85 cm2/m2 and severe defined as<0.65 cm2/m2.
【Results】
3D planimetered AoA area decreased after TAVI(P<0.001)whereas the LVOT increased(P=0.004). The eccentricity of both AoA and LVOT decreased after TAVI(both, P<0.001). At discharge, the incidence of overall and severe PPM was 44%and 12%,respectively. Patients with PPM had a larger body surface area(1.94±0.27 m2 vs. 1.77±0.24 m2,P<0.001), smaller aortic valve area(0.60±0.14 cm2 vs. 0.65±0.16 cm2,P=0.040), and less frequent balloon dilation(81%versus 93%,P=0.033). Despite similar area cover index, patients with PPM had a lower post-TAVI AoA area / pre-TAVI AoA area(91±8%vs. 95±7%,P=0.001)than those without PPM. The post-TAVI AoA area / pre-TAVI AoA area was independently associated with overall PPM(per 10%decrease: odds ratio, 1.80; 95%CI, 1.06-3.05; P=0.031)and severe PPM(per 10%decrease: odds ratio, 2.50; 95%CI, 1.05-5.36; P=0.04). Additionally, a cut-off value of this ratio>86.3%had a sensitivity of 84%and a specificity of 44%for the prevention of severe PPM.
【Conclusion】
3D-TEE can evaluate geometric changes in AoA and LVOT during balloon-expandable TAVI and predicts post-procedural PPM.