The Role of Quantitative Aortographic Assessment of Aortic Regurgitation by Videodensitometry in the Guidance of Transcatheter Aortic Valve Implantation

Abstract Background: Balloon post-dilatation (BPD) is often needed for optimizing transcatheter heart valve (THV) implantation, since paravalvular leak (PVL) after transcatheter aortic valve implantation is associated with poor outcome and mortality. Quantitative assessment of PVL severity before and after BPD is mandatory to properly assess PVL, thus improving implantation results and outcomes. Objective: To investigate a quantitative angiographic assessment of aortic regurgitation (AR) by videodensitometry before and after BPD. Methods: Videodensitometric-AR assessments (VD-AR) before and after BPD were analysed in 61 cases. Results: VD-AR decreased significantly from 24.0[18.0-30.5]% to 12.0[5.5-19.0]% (p < 0.001, a two-tailed p < 0.05 defined the statistical significance). The relative delta of VD-AR after BPD ranged from -100% (improvement) to +40% (deterioration) and its median value was -46.2%. The frequency of improvement, no change, and deterioration were 70% (n = 43), 25% (n = 15) and 5% (n = 3), respectively. Significant AR (VD-AR > 17%) was observed in 47 patients (77%) before and in 19 patients (31%) after BPD. Conclusions: VD-AR after THV implantation provides a quantitative assessment of post-TAVI regurgitation and can help in the decision-making process on performing BPD and in determining its efficacy.

摘要 背景：球囊后扩张（Balloon post-dilatation, BPD）常用于优化经导管心脏瓣膜（transcatheter heart valve, THV）植入术，因为经导管主动脉瓣植入术（transcatheter aortic valve implantation, TAVI）后的瓣周漏（paravalvular leak, PVL）与不良预后及死亡率密切相关。对BPD术前及术后的PVL严重程度进行定量评估，是精准评估PVL、优化手术植入效果及患者预后的必要环节。
目的：探讨采用视频密度法（videodensitometry）定量评估主动脉瓣反流（aortic regurgitation, AR）在BPD术前及术后的应用价值。
方法：本研究对61例患者在BPD术前及术后的视频密度法主动脉瓣反流评估（videodensitometric-aortic regurgitation, VD-AR）结果进行了分析。
结果：VD-AR评分从术前的24.0[18.0-30.5]%显著降至术后的12.0[5.5-19.0]%（p<0.001，双侧检验以p<0.05为统计学显著性阈值）。BPD术后VD-AR的相对变化幅度范围为-100%（完全改善）至+40%（恶化），中位值为-46.2%。患者中改善、无变化及恶化的比例分别为70%（n=43）、25%（n=15）及5%（n=3）。术前有47例患者（77%）存在重度主动脉瓣反流（VD-AR>17%），术后该比例降至31%（n=19）。
结论：经THV植入术后的VD-AR可对TAVI术后反流进行定量评估，有助于辅助临床决策是否需实施BPD，并评估该手术的治疗效果。