METHODS: We performed a retrospective analysis of 190 patients undergoing balloon-expandable TAVI at a single center. Manifestation of infra-annular extension of RCC/NCC was considered to be present when part of leaflet extended below aortic-annular plane on post-implantation aortic-root angiography.
RESULTS: Infra-annular extension of RCC/NCC was observed in 33 patients (17.37%). PPI incidence post-TAVI was higher in patients with infra-annular extension of RCC/NCC than in those without (36.36% versus 8.92%, relative-risk: 4.08, p˂0.0001). On logistic-regression analysis, preexisting right bundle-branch block (RBBB) (odds-ratio: 12.73, 95% confidence-interval: 2.16-74.93, p = 0.005), and infra-annular extension of RCC/NCC (odds-ratio: 5.63, 95% confidence-interval: 2.17-14.58, p < 0.0001) were independently associated with PPI risk. Preexisting RBBB (φ = +0.25, p = 0.001) and infra-annular extension of RCC/NCC (φ = +0.30, p < 0.0001) showed a positive-correlation with PPI risk. Infra-annular extension of RCC/NCC was a significant predictor of PPI risk on receiver-operating-characteristic curve analysis (area under-the-curve 0.67; 95% confidence-interval: 0.54-0.79, p = 0.006).
CONCLUSIONS: The retained native aortic leaflets play a significant role in PPI risk following balloon-expandable TAVI. Infra-annular extension of RCC/NCC is a novel predictor, and is associated with a four-fold higher risk of PPI.
方法:我们对190例单中心球囊扩张TAVI患者进行了回顾性分析。在植入后的主动脉根血管造影术中,当小叶的一部分延伸到主动脉环形平面以下时,认为存在RCC/NCC的环形延伸表现。
结果:在33例患者(17.37%)中观察到RCC/NCC的环状扩张。有肾癌/NCC环下扩张的患者在TAVI后的PPI发生率高于无(36.36%对8.92%,相对风险:4.08,p<0.0001)。在逻辑回归分析中,先前存在的右束支传导阻滞(RBBB)(比值比:12.73,95%置信区间:2.16-74.93,p=0.005),RCC/NCC(比值比:5.63,95%置信区间:2.17-14.58,p<0.0001)与PPI风险独立相关.先前存在的RBBB(φ=0.25,p=0.001)和RCC/NCC的环下延伸(φ=0.30,p<0.0001)与PPI风险呈正相关。在受试者工作特征曲线分析中,RCC/NCC的环形延伸是PPI风险的重要预测因子(曲线下面积0.67;95%置信区间:0.54-0.79,p=0.006)。
结论:保留的天然主动脉小叶在球囊扩张TAVI后的PPI风险中起重要作用。RCC/NCC的环形延伸是一种新的预测因子,并且与PPI的风险高四倍有关。