microcirculationРегионарное кровообращение и микроциркуляцияRegional blood circulation and microcirculation1682-66552712-9756Academician I.P. Pavlov First St. Petersburg State Medical University10.24884/1682-6655-2022-21-1-27-35microcirculation-1037Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИ (КЛИНИЧЕСКИЕ ИССЛЕДОВАНИЯ)ORIGINAL ARTICLES (CLINICAL INVESTIGATIONS)Кальциноз аортального клапана как возможный предиктор парапротезной регургитации после транскатетерной имплантации протеза аортального клапанаCalcification of the aortic valve as a possible predictor of paraprosthetic regurgitation after transcatheter aortic valve implantationhttps://orcid.org/0000-0001-5157-3755КуликовД. И.KulikovD. I.

Куликов Дмитрий Игоревич – врач

194017, Санкт-Петербург, пр. Тореза, д.72, лит. А

Kulikov Dmitriy I. – X-ray surgeon

72, Toreza str., Saint Petersburg, Russia, 194017

dockulikov@rambler.ruhttps://orcid.org/0000-0002-1447-3509ЗверевД. А.ZverevD. A.

Зверев Дмитрий Анатольевич – канд. мед. наук, доценткафедры общей хирургии; зав. отделением

197341, Санкт-Петербург, ул. Аккуратова, д. 2; 238312, Калининградская обл., Гурьевский район, пос. Родники, ш. Калининградское, д. 4

Zverev Dmitriy A. – Ph. D., Associate Professor at the Department of General Surgery

2, Akkuratova str., Saint Petersburg, Russia, 197341; 4, Kaliningrad Highway, Rodniki, Guryevsky district, Kaliningrad region, 238312

dmitry_zverev@yahoo.comhttps://orcid.org/0000-0002-4273-5086СтрелковД. А.StrelkovD. A.

Стрелков Дмитрий Алексеевич – младший научный сотрудник, врач

197341, Санкт-Петербург, ул. Аккуратова, д. 2

Strelkov Dmitriy A. – Research Assistant, X-ray surgeon

2, Akkuratova str., Saint Petersburg, Russia, 197341

dmitristrelkov111@gmail.comhttps://orcid.org/0000-0003-1540-5337ПищугинА. С.PishchuginA. S.

Пищугин Александр Сергеевич – аспирант, врач

197341, Санкт-Петербург, ул. Аккуратова, д. 2

Pishchugin Aleksandr S. – Postgraduate, X-ray surgeon

2, Akkuratova str., Saint Petersburg, Russia, 197341

pischuginalexander@gmail.comФедеральное государственное бюджетное учреждение здравоохранения «Санкт-Петербургская клиническая больница Российской академии наук»РоссияSaint-Petersburg city clinical hospital of Russian Scientific AcademyRussian FederationФедеральное государственное бюджетное учреждение «Национальный медицинский исследовательский центр имени В. А. Алмазова» Министерства здравоохранения Российской Федерации; Федеральное государственное бюджетное учреждение «Федеральный центр высоких медицинских технологий» Министерства здравоохранения Российской ФедерацииРоссияV. A. Almazov National Medical Research Centre;Kaliningrad Federal Cardiovascular Surgery CenterRussian FederationФедеральное государственное бюджетное учреждение «Национальный медицинский исследовательский центр имени В. А. Алмазова» Министерства здравоохранения Российской ФедерацииРоссияV. A. Almazov National Medical Research CentreRussian Federation2022110420222112735Copyright © Куликов Д.И., Зверев Д.А., Стрелков Д.А., Пищугин А.С., 20222022Куликов Д.И., Зверев Д.А., Стрелков Д.А., Пищугин А.С.Kulikov D.I., Zverev D.A., Strelkov D.A., Pishchugin A.S.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.microcirc.ru/jour/article/view/1037Введение

Введение. Развитие парапротезной регургитации после транскатетерного протезирования аортального клапана (TAVI) у пациентов с критическим аортальным стенозом остается актуальной проблемой, предикторы которой недостаточно изучены. Одной из основных причин является кальциноз структур аортального клапана, препятствующий адекватному расправлению протеза аортального клапана.

Цель – выявить возможную связь между тяжестью кальциноза аортального клапана и степенью парапротезной регургитации после TAVI.

Материалы и методы

Материалы и методы. В исследование включены 23 пациента с критическим симптоматическим аортальным стенозом и высокими факторами рисков по EuroScore II и по STS. Исследование представляет собой ретроспективный, одноцентровой анализ кальцификации аортального клапана по результатам предоперационной мультиспиральной компьютерной томографии. Количественную оценку кальциноза (кальциевый индекс) аортального клапана выполняли по методике Агатсона. Парапротезная регургитация оценивалась на трансторакальной эхокардиографии в соответствии с рекомендациями ACC/AHA. Период наблюдения составил 12 месяцев.

Результаты

Результаты. В исследуемой группе преобладали пациенты женского пола (n=15, 65 %). Среднее значение кальциевого индекса (КИ) аортального клапана составило 5179,7±2334,1 условной единицы Агатсона. Интраоперационно у половины пациентов (n=12, 52 %) после имплантации протеза аортального клапана выявлена парапротезная регургитация более II степени, что потребовало выполнения постдилатации. Кальциевый индекс в этой выборке пациентов был достоверно выше (6088,3±2274,4, p=0,049). После операции парапротезная регургитация I–II степени сохранялась у 16 пациентов (70 %) с КИ 5902,1±2191,9, парапротезная регургитация отсутствовала у 7 пациентов (30 %) с КИ 3528,7±1537,2 (p=0,021). За последующий период послеоперационного наблюдения (12 месяцев) летальных исходов в исследуемой группе не выявлено. Парапротезная регургитация I–II степени зафиксирована у 14 пациентов с КИ 5676,6±2275, парапротезная регургитация отсутствовала у 9 пациентов с КИ 4406,9±2338,3 (р=0,21).

Заключение

Заключение. Таким образом, пациенты с выраженным кальцинозом аортального клапана имеют повышенный риск развития значимой парапротезной регургитации, а также необходимость применения более агрессивной техники вмешательства.

Introduction

Introduction. The development of paraprosthetic regurgitation after transcatheter aortic valve implantation (TAVI) in patients with critical aortic stenosis is an actual problem, which predictors are not well understood. One of the main reasons is calcification of the aortic valve, which does not allow the aortic valve prosthesis to fully expand.

Objective – to identify a possible relationship between the severity of aortic valve calcification and the degree of paraprosthetic regurgitation after TAVI.

Materials and methods

Materials and methods. The study included 23 patients with critical symptomatic aortic stenosis and high risk factors for EuroScore II and STS. The single center study is a retrospective analysis of aortic valve calcification measured by preoperative multislice computed tomography. Calcification (calcium index) of the aortic valve was quantified according to the Agatson method. Paraprosthetic regurgitation was evaluated by transthoracic echocardiography according to the ACC/AHA recommendations. The observation period was 12 months. Results. There female patients predominated in the study group (n=15, 65 %). The mean value of the calcium index (CI) of the aortic valve was 5179.7±2334.1 Agatson units. Intraoperatively, half of the patients (n=12, 52 %) after implantation of aortic valve prosthesis had paraprosthetic regurgitation of more than II degree, which required postdilation. The calcium index in this group of patients was significantly higher (6088.3±2274.4, p=0.049). After implantation of an aortal valve prosthesis, paraprosthetic regurgitation of I–II degrees was observed in 16 patients (70 %) with a CI of 5902.1±2191.9, in 7 patients (30 %) with a CI of 3528.7±1537.2 paraprosthetic regurgitation was absent (p=0.021). In the postoperative period (12 months), no lethal outcomes were detected in the study group. Paraprosthetic regurgitation of I–II degrees was detected in 14 patients with a CI of 5676.6±2275, paraprosthetic regurgitation was absent in 9 patients with a CI of 4406.9±2338.3 (p=0.21).

Conclusion

Conclusion. Patients with severe calcification of the aortic valve have an increased risk of developing significant paraprosthetic regurgitation and the use of more aggressive intervention techniques.

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The authors declare that there are no conflicts of interest present.