Imaging Anatomic Features and Risk Classification in Patients With Pure Aortic Valve Regurgitation
10.3969/j.issn.1000-3614.2025.04.010
- VernacularTitle:单纯主动脉瓣反流患者行经导管主动脉瓣置换术前的影像学特征与解剖风险分型
- Author:
Mingcheng FANG
1
;
Sicheng ZHANG
;
Jingxuan HONG
;
Xinjing CHEN
;
Yansong GUO
Author Information
1. 福州大学附属省立医院 福建医科大学省立临床医学院 福建省立医院 心内科,福州 350001
- Publication Type:Journal Article
- Keywords:
aortic regurgitation;
anatomical risk point;
anatomical risk classification;
transcatheter aortic valve replacement
- From:
Chinese Circulation Journal
2025;40(4):380-387
- CountryChina
- Language:Chinese
-
Abstract:
Objectives:To evaluate preoperative imaging anatomic characteristics and risk stratification in patients with pure aortic regurgitation(PAR)who underwent transcatheter aortic valve replacement(TAVR).Methods:A total of 156 consecutive patients with moderate or severe PAR who underwent TAVR from January 2018 to June 2023 in Fujian Provincial Hospital were enrolled.Pre-procedural aortic root computed tomography scans of the patients were analyzed to summarize anatomical risk points and typing.The clinical baseline data,perioperative data,and postoperative 12-month adverse events during follow-up of patients with different typing were compared.Results:The mean age of the 156 PAR patients treated with TAVR was(72.8±6.4)years,69.2%were male,and the STS score was(7.7±2.0)%.The proportion of PAR patients with simple,general and challenging lesions was 9.0%,37.8%and 53.2%,respectively.Results showed that enrolled patients with PAR treated with TAVR were at high risk of valve displacement(47.4%),and the risk of perivalvular leakage(26.9%),ascending aortic dilatation(26.9%),low coronary artery opening(37.2%)and transverse heart(23.7%)were also common.The risk of valve displacement and perivalvular leakage were significantly higher in PAR patients with challenging lesions.The risk of perioperative complications was significantly higher in patients with challenging and general lesions than in patients with simple lesions,and the most common complications were new left bundle branch block and pacemaker implantation.The 12-month adverse event rates after TAVR in PAR patients with simple,general,and challenge lesions were 0%,15.3%,and 32.5%,respectively,and the difference was statistically significant(P=0.004).Multivariate logistic regression analysis showed that PAR patients with challenging lesions had a significantly higher risk of multiple endpoint events 12 months after surgery than those with non-challenging lesions(OR=3.38,95%CI:1.48-8.38,P=0.006).Conclusions:Careful assessment of anatomic risk typing by preoperative imaging in PAR patients undergoing TAVR is important for risk stratification of perioperative complications as well as adverse events during follow-up.
