| Part I:The impact of ascending aortic dilatation on prognosis and its transformation post TAVRObjective:Based on the analysis of clinical data,echocardiography measurements,procedural data and follow-up information between the patients with and without ascending aortic dilatation,we tried to explore the impact of ascending aortic dilatation on prognosis after TAVR and diameter transformation of ascending aorta post TAVR.Methods:Patients who underwent TAVR in the Second Affiliated Hospital of Zhejiang University from March 2013 to September 2016,were enrolled.Patients were excluded if they had pure aortic regurgitation,or had previously received surgical aortic valve replacement or TAVR,or didn’t have pre-procedural CTA and echocardiography.We analyzed clinical data,echocardiography measurements,procedural data and follow-up information at 1 month,6months and 1 year in the patients with and without ascending aortic dilatation,to explore the safety of patients with ascending aortic dilatation undergoing TAVR,and to investigate the changes of diameter of ascending aorta post TAVR.Results:168 patients were involved in this study,among which 92 were patients with ascending aortic dilatation(diameter of ascending aortic dilatation>40mm),and 76 without ascending aortic dilatation(diameter of ascending aortic dilatation<40mm-.Left ventricular ejection fraction(LVEF)was significantly higher in patients without ascending aortic dilatation compared with those with dilatation(52.6[40.1-61.7]vs.58.0[48.0-64.7],P=0.028).There was no significant difference between these two groups when comparing aortic mean pressure gradient,aortic valve area,and aortic peak velocity.The incidence of mild and above paravalvular leakage was significantly higher in patients with ascending aortic dilatation compared with those without dilatation(54%vs.28%,P=0.034).1-year mortality after TAVR was similar between two groups(13.1%vs.7.3%,P=0.518).Based on the measurement of CTA before and 1 year after TAVR,at the level of 4 cm above aortic annulus,the maximum,and mean diameters showed no significant changes at 1 year after TAVR.While the minimum diameter increased 0.29±1.23 mm at 1 year.At the widest level of ascending aorta,the maximum diameter decreased 0.60±0.84 mm at 1 year after TAVR and mean diameters decreased 0.28±0.73 mm,while the minimum diameters didn’t change significantly.The similar results were found At the widest level of ascending aorta for both patients with bicuspid aortic valve(BAV)and patients with tricuspid aortic valve(TAV).Conclusions:The concomitant ascending aortic dilatation did not affect mortality,stroke,severe bleeding,myocardial infarction and new-onset atrial fibrillation post TAVR.The incidence of mild paravalvular leakage was higher in patients with ascending aortic dilatation.At 1 year,the minimum diameter at the level of 4 cm above aortic annulus increased,while the maximum diameter and mean diameters decreased at the widest level of ascending aorta.Part Ⅱ:The impact of aortic angulation on prognosis post TAVRObjective:Based on the analysis of clinical data,echocardiography measurements,procedural data and follow-up information of patients,we tried to explore the impact of aortic angulation(AA)on the immediate outcome,mortality,complication rate and functional improvement of the aortic valve.Methods:Patients who underwent TAVR in the Second Affiliated Hospital of Zhejiang University from March 2013 to September 2016,were enrolled.Patients were excluded if they had pure aortic regurgitation,or had previously received surgical aortic valve replacement or TAVR,or didn’t have pre-procedural CTA and echocardiography.Patients were categorized as AA≤54° or AA>54° for analysis of baseline data,procedural data,and complication rate at 1 month,6 months and 1 year to explore the impact of AA on safety and prognosis post TAVR.Patients were also grouped as bicuspid aortic valve(BAV)or tricuspid aortic valve(TAV)for subgroup analysis.Results:168 patients were involved in the study,90 of which were patients with AA<54°,78 with AA>54°.There was no significant difference between the two groups when compared basic clinical characteristics.BAV were more common in AA>540 compared with AA≤54°(45%vs.28%,P=0.021).There was no significant difference between the two groups as to anesthesia type,accesses,prosthesis type,valve-in-valve,balloon pre-dilation,balloon post-dilation,patient-prosthesis mismatch and procedural time.For BAV patients,those with AA≤54° have higher device success rate than those with AA>54°(88%vs.63%,P=0.040).There is no difference of complications in hospital or during follow up after TAVR between patients with AA≤54° and with AA>54°.Transvalvular pressure gradient,aortic valve area,and aortic peak velocity were also similar between AA≤54° and AA>54°during follow up.Kaplan-Meier survival analysis revealed no significant difference between AA<54° and AA>54°(P=0.280).In patients with TAV,there is higher pacemaker implantation rate within 6 months in patients with AA>54° than AA≤54°(16%vs.44%,P=0.003).Moderate to severe paravalvular aortic regurgitation(PAR)rate were higher in patients with AA>54° than those with AA≤54°(19%vs.2%,P=0.016)in echocardiography at 1 year.Conclusions:The aortic angulation did not affect the survival rate and functional improvement of aortic valve in patients undergoing TAVR.Larger aortic angulation increased the incidence of moderate to severe paravalvular aortic regurgitation,decreased the rate of device success in patients with BAV,and increased the rate of pacemaker implantation in patients with TAV.Thus,aortic angulation may affect device success,moderate to severe paravalvular aortic regurgitation and pacemaker implantation post TAVR. |
PDF Full Text Request