经导管主动脉瓣置换术后发生瓣周漏患者的临床特征及危险因素分析

Objective The aim of this study was to analyze the clinical characteristics and risk factors of patients who developed moderate or higher perivalvular leak （PVL） after transcatheter aortic valve replacement （TAVR）. Methods A retrospective cohort study was conducted in the Second Affliated Hospital of Nanchang University from January 2018 to November 2022. Patients with severe aortic stenosis who underwent TAVR were included in this study. Based on the ratio of aortic regurgitant bundle length to annular circumference measured by transesophageal echocardiography immediately after valve implantation， patients were divided into two groups： PVL＜3/4 and PVL≥3/4. The clinical characteristics， echocardiography， and CT scan analysis of the aortic root were compared between the two groups. Independent risk factors for postoperative PVL≥3/4 were identified using a multivariable Logistic regression model， and the predictive value of each risk factor for PVL≥3/4 was analyzed using receiver operating characteristic （ROC） curves. Results A total of 107 patients were included in the study， with an average age of （71.7±7.0） years， and 63 （58.9%） were male. There were 70 patients in the PVL＜3/4 group and 37 in the PVL≥3/4 group. The percentage of males， left ventricular end-diastolic diameter， left ventricular end-systolic diameter， annular diameter， and annular calcification volume were all higher in the PVL≥3/4 group compared to the PVL＜3/4 group （all P＜0.05）. In contrast，relative ventricular wall thickness （RWT） was smaller in the PVL≥3/4 group compared to the PVL＜3/4 group （P＜0.05）. There was a trend for the mean left ventricular outflow tract diameter to be larger in the PVL≥3/4 group compared to the PVL＜3/4 group， but the difference was not statistically significant P=0.058）. RWT was transformed and defined as RWTd， the reciprocal of RWT. Multivariable Logistic regression analysis was used to identify independent risk factors for moderate or greater PVL after Venus-A valve implantation with TAVR. The results showed that RWTd and calcification volume were independent risk factors for the development of moderate or greater PVL after TAVR（both P＜0.05）. The ROC curves showed that RWTd （AUC=0.658，95%CI 0.554－0.763， P=0.007） and calcification volume （AUC=0.657， 95%CI 0.554－0.759， P=0.008） were predictive of the development of moderate or greater PVL after TAVR. Conclusions Patients with moderate or higher PVL had more severe preoperative LV remodeling and a LV ejection fraction in the low normal range； RWTd as well as aortic valve calcification volume were independent risk factors for the development of moderate or greater PVL after TAVR， both of which were valuable in predicting severe PVL after TAVR.