Clinical Impact of Midframe Underexpansion Following TAVR Using a Self-Expanding Transcatheter Heart Valve

IF 11.7 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Cardiovascular interventions Pub Date : 2025-04-28 DOI:10.1016/j.jcin.2025.02.013

Won-Keun Kim MD , Ole de Backer MD , Matthias Renker MD , Efstratios I. Charitos MD, PhD , Chris Frawley BSME , Yusuke Kobari MD , Mohamed Abdel-Wahab MD , Ahmed Abdelhafez MD , Niklas Lankisch MD , Darren Mylotte MD , Osama Soliman MD, PhD , Michael Joner MD , Helge Möllmann MD , Yeong-Hoon Choi MD , Samuel Sossalla MD

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引用次数: 0

Abstract

Background

The occurrence and clinical impact of transcatheter heart valve midframe underexpansion following transcatheter aortic valve replacement are not well understood.

Objectives

The aim of this study was to evaluate midframe underexpansion among patients treated with the self-expanding ACURATE neo2 device.

Methods

This retrospective analysis included 604 patients (median age 82 years; Q1-Q3: 78-85 years; 61.4% women) from 2 European high-volume centers. Midframe underexpansion was assessed on postimplantation fluoroscopic images and defined as nonparallelism of commissure posts. The primary endpoint was a composite of all-cause mortality, stroke, or rehospitalization at 1 year.

Results

Midframe underexpansion was identified in 13.9% of patients (84 of 604) and was associated with higher rates of the primary endpoint (33 of 84 [39.3%; 95% CI: 28.8%-50.5%] vs 54 of 520 [10.4%; 95% CI: 7.9%-13.3%]; P < 0.001) and each of its components. Furthermore, midframe underexpansion was independently associated with 1-year all-cause mortality (adjusted HR: 4.07; 95% CI: 2.26-7.33; P < 0.001). The only independent predictor of midframe underexpansion was the absence of postdilatation (adjusted OR: 5.76; 95% CI: 2.60-12.77; P < 0.001). Postdilatation significantly decreased the rate and extent of midframe underexpansion.

Conclusions

In this European cohort of ACURATE neo2 recipients, midframe underexpansion occurred in a minor proportion and was associated with poorer clinical outcomes through 1 year. Postdilatation effectively reduced the rate and extent of midframe underexpansion.

查看原文本刊更多论文

经导管自扩张心脏瓣膜对TAVR术后中机架扩张不足的临床影响

背景经导管主动脉瓣置换术后经导管心脏瓣膜中部扩张不足的发生及临床影响尚不清楚。目的：本研究的目的是评估使用自扩张的accurate neo2装置治疗的患者中机架扩张不足的情况。方法回顾性分析604例患者(中位年龄82岁；Q1-Q3: 78-85岁；61.4%女性)，来自2个欧洲高容量中心。在植入后的透视图像上评估中间帧扩张不足，并将其定义为接合桩的不平行。主要终点是全因死亡率、卒中或1年后再住院的综合指标。结果：13.9%的患者（604例中有84例）发现了midframe扩张不足，并与较高的主要终点发生率相关(84例中有33例[39.3%；95% CI: 28.8%-50.5%] vs 54 / 520 [10.4%；95% ci: 7.9%-13.3%]；P & lt;0.001)及其每个分量。此外，体格扩张不足与1年全因死亡率独立相关(校正风险比：4.07；95% ci: 2.26-7.33；P & lt;0.001)。中期扩张不足的唯一独立预测因子是没有扩张后(调整OR: 5.76；95% ci: 2.60-12.77；P & lt;0.001)。扩张后显著降低了中部欠扩张的速度和程度。结论：在这个欧洲的acate新氧受体队列中，中位扩张不足发生的比例较小，并且与1年内较差的临床结果相关。后扩张有效地降低了中部欠扩张的速度和程度。

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

JACC. Cardiovascular interventions CARDIAC & CARDIOVASCULAR SYSTEMS-

CiteScore

11.60

自引率

8.80%

发文量

756

审稿时长

4-8 weeks

期刊介绍： JACC: Cardiovascular Interventions is a specialist journal launched by the Journal of the American College of Cardiology (JACC). It covers the entire field of interventional cardiovascular medicine, including cardiac, peripheral, and cerebrovascular interventions. The journal publishes studies that will impact the practice of interventional cardiovascular medicine, including clinical trials, experimental studies, and in-depth discussions by respected experts. To enhance visual understanding, the journal is published both in print and electronically, utilizing the latest technologies.