Feasibility of redo-TAVI in the self-expanding ACURATE neo2 valve: a computed tomography study.

IF 7.6 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Eurointervention Pub Date : 2024-11-18 DOI:10.4244/EIJ-D-24-00367

Gintautas Bieliauskas, Yusuke Kobari, Arif A Khokhar, Mohamed Abdel-Wahab, Ahmed Abdelhafez, Miho Fukui, Klaus Fuglsang Kofoed, Dariusz Dudek, Andreas Fuchs, Joao Cavalcante, Kentaro Hayashida, Gilbert H L Tang, Darren Mylotte, Vinayak N Bapat, Ole De Backer

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引用次数: 0

Abstract

Background: Redo-transcatheter aortic valve implantation (TAVI) may be unfeasible because of the risk of compromising coronary flow or coronary access by the pinned back leaflets of the index transcatheter aortic valve.

Aims: We aimed to evaluate the feasibility of redo-TAVI using the balloon-expandable SAPIEN 3 (S3) implanted within the self-expanding ACURATE neo2 (ACn2) valve and to identify predictors associated with a high risk of compromising coronary flow.

Methods: A total of 153 post-ACn2 TAVI cardiac computed tomography scans were analysed. Redo-TAVI using an S3 was simulated in two positions: S3 outflow to the ACn2 upper crown (low implant) and S3 outflow to the base of the ACn2 commissural posts (high implant). The risk for coronary flow compromise and inaccessibility was determined by the height of the neoskirt created by the pinned back leaflets and the valve-to-aorta distances.

Results: At a low S3 implant position, risk of coronary flow compromise was predicted in only 8% of patients and this increased to 60% with a high S3 position. In accordance, coronary access was predicted to be unrestricted in 52% versus 13% of patients with a low versus high S3 implantation. Female sex, a small aortic annular dimension and a sinotubular junction-to-aortic annulus mean diameter ratio <1.15 were independent predictors associated with a high risk for coronary flow compromise.

Conclusions: The feasibility of redo-TAVI with an S3 in an ACn2 depends on the implant depth of the S3 and the geometry of the surrounding aorta. A low S3 implant may reduce the risk of coronary flow compromise and inaccessibility.

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在自扩张 ACURATE neo2 瓣膜上重新进行 TAVI 的可行性：一项计算机断层扫描研究。

背景：重做经导管主动脉瓣植入术（TAVI）可能不可行，因为有可能因指数经导管主动脉瓣的针状后叶而影响冠状动脉血流或冠状动脉通路。目的：我们旨在评估使用植入自膨胀 ACURATE neo2（ACn2）瓣膜内的球囊扩张型 SAPIEN 3（S3）重新进行经导管主动脉瓣置换术的可行性，并确定与冠状动脉血流受损高风险相关的预测因素：方法：共分析了153例ACn2 TAVI术后心脏计算机断层扫描。在两个位置模拟了使用 S3 的重新 TAVI：S3流出到ACn2上冠（低植入位置）和S3流出到ACn2基底部（高植入位置）。冠状动脉血流受阻和无法进入的风险由夹住的后叶形成的新裙的高度和瓣膜到主动脉的距离决定：结果：在低 S3 植入位置，预计只有 8% 的患者有冠状动脉血流受损的风险，而在高 S3 位置，这一比例上升到 60%。因此，在低 S3 和高 S3 植入位置的患者中，冠状动脉通路不受限制的比例分别为 52% 和 13%。女性、主动脉瓣环尺寸较小、窦管交界处与主动脉瓣环平均直径比结论：在 ACn2 中使用 S3 重做 TAVI 的可行性取决于 S3 的植入深度和周围主动脉的几何形状。低S3植入可降低冠状动脉血流受损和无法进入的风险。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Eurointervention CARDIAC & CARDIOVASCULAR SYSTEMS-

CiteScore

10.30

自引率

4.80%

发文量

380

审稿时长

3-8 weeks

期刊介绍： EuroIntervention Journal is an international, English language, peer-reviewed journal whose aim is to create a community of high quality research and education in the field of percutaneous and surgical cardiovascular interventions.