{"title":"使用计算机断层扫描引导的主动脉瓣新瓣化技术进行个性化主动脉瓣置换术。与标准尾崎技术相比的中期效果分析。","authors":"Igor Mokryk , Bogdan Batsak , Illia Nechai , Ihor Stetsyuk , Borys Todurov","doi":"10.1016/j.jcct.2024.03.013","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><p>The original Ozaki technique involves sizing the neovalve cusps during cross-clamp. It leads to prolonging the ischemic time compared to standard surgical AVR. Measurements taken on the collapsed Aortic Root (AR) may also be inaccurate. We use preoperative Computed Tomography (CT) to perform more accurate sizing in physiological conditions and shorten the ischemic time. This study analyzes the results of the CT-guided Aortic Valve Neocuspidization (AVNeo) compared with the Ozaki technique.</p></div><div><h3>Methods</h3><p>The validity of the concept was evaluated ex vivo. Experimental valves underwent geometric, CT, and hydrodynamic controls. In the clinical phase of the study, we prospectively analyzed patients who received CT-guided AVNeo (N = 7, Group 1). The control group enrolled patients who were operated on after the standard AVNeo technique (N = 15, Group 2).</p></div><div><h3>Results</h3><p>In Group 1, Aortic Cross-Clamp (70.3 ± 17.0 vs. 91 ± 21.3 min, ρ = 0.026) and Bypass times (92.9 ± 21.0 vs. 123 ± 24.8 min, ρ = 0.011) were significantly shorter. At discharge, the peak (11.7 ± 2.75 vs. 15.4 ± 4.66 mm Hg, ρ = 0.032) and mean Aortic Valve (AV) gradient (6.29 ± 1.25 vs. 7.87 ± 2.33 mm Hg, ρ = 0.052) were lower in Group 1. Only one patient in Group 2 had Aortic Insufficiency (AI) greater than mild. The mean follow-up was 49.6 ± 6.9 months in both groups. There were no late deaths or any valve-related events detected in any patient. EchoCG revealed that peak (10.0 ± 2.65 vs. 12.6 ± 4.05 mm Hg, ρ = 0.090) and mean AV gradient (5.14 ± 1.35 vs. 6.73 ± 2.25 mm Hg, ρ = 0.054) also were lower in Group 1. AI indexes were stable in both Groups.</p></div><div><h3>Conclusions</h3><p>CT-guided AVNeo is an example of personalized medicine in the surgical treatment of heart valve pathology. It allows the development of a biological AV that adapts to the patient's anatomy, shortens ischemic time, and results in better hemodynamics.</p><p>A more significant number of clinical observations and longer follow-up are warranted to prove the viability of the concept.</p></div>","PeriodicalId":49039,"journal":{"name":"Journal of Cardiovascular Computed Tomography","volume":null,"pages":null},"PeriodicalIF":5.5000,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"A personalized aortic valve replacement using computed tomography-guided aortic valve neocuspidization. Analysis of mid-term results compared to standard Ozaki technique\",\"authors\":\"Igor Mokryk , Bogdan Batsak , Illia Nechai , Ihor Stetsyuk , Borys Todurov\",\"doi\":\"10.1016/j.jcct.2024.03.013\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><p>The original Ozaki technique involves sizing the neovalve cusps during cross-clamp. It leads to prolonging the ischemic time compared to standard surgical AVR. Measurements taken on the collapsed Aortic Root (AR) may also be inaccurate. We use preoperative Computed Tomography (CT) to perform more accurate sizing in physiological conditions and shorten the ischemic time. This study analyzes the results of the CT-guided Aortic Valve Neocuspidization (AVNeo) compared with the Ozaki technique.</p></div><div><h3>Methods</h3><p>The validity of the concept was evaluated ex vivo. Experimental valves underwent geometric, CT, and hydrodynamic controls. In the clinical phase of the study, we prospectively analyzed patients who received CT-guided AVNeo (N = 7, Group 1). The control group enrolled patients who were operated on after the standard AVNeo technique (N = 15, Group 2).</p></div><div><h3>Results</h3><p>In Group 1, Aortic Cross-Clamp (70.3 ± 17.0 vs. 91 ± 21.3 min, ρ = 0.026) and Bypass times (92.9 ± 21.0 vs. 123 ± 24.8 min, ρ = 0.011) were significantly shorter. At discharge, the peak (11.7 ± 2.75 vs. 15.4 ± 4.66 mm Hg, ρ = 0.032) and mean Aortic Valve (AV) gradient (6.29 ± 1.25 vs. 7.87 ± 2.33 mm Hg, ρ = 0.052) were lower in Group 1. Only one patient in Group 2 had Aortic Insufficiency (AI) greater than mild. The mean follow-up was 49.6 ± 6.9 months in both groups. There were no late deaths or any valve-related events detected in any patient. EchoCG revealed that peak (10.0 ± 2.65 vs. 12.6 ± 4.05 mm Hg, ρ = 0.090) and mean AV gradient (5.14 ± 1.35 vs. 6.73 ± 2.25 mm Hg, ρ = 0.054) also were lower in Group 1. AI indexes were stable in both Groups.</p></div><div><h3>Conclusions</h3><p>CT-guided AVNeo is an example of personalized medicine in the surgical treatment of heart valve pathology. It allows the development of a biological AV that adapts to the patient's anatomy, shortens ischemic time, and results in better hemodynamics.</p><p>A more significant number of clinical observations and longer follow-up are warranted to prove the viability of the concept.</p></div>\",\"PeriodicalId\":49039,\"journal\":{\"name\":\"Journal of Cardiovascular Computed Tomography\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":5.5000,\"publicationDate\":\"2024-07-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Cardiovascular Computed Tomography\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S1934592524000728\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"CARDIAC & CARDIOVASCULAR SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Cardiovascular Computed Tomography","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1934592524000728","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
引用次数: 0
摘要
背景：最初的尾崎技术涉及在交叉钳夹时确定新瓣尖的大小。与标准手术 AVR 相比，这种方法会延长缺血时间。对塌陷的主动脉根（AR）进行的测量也可能不准确。我们使用术前计算机断层扫描（CT）在生理条件下进行更精确的尺寸测量，缩短缺血时间。本研究分析了 CT 引导下主动脉瓣新焦点化术（AVNeo）与 Ozaki 技术的比较结果：方法：对该概念的有效性进行了体内评估。实验瓣膜接受了几何、CT 和流体力学控制。在临床研究阶段，我们对接受 CT 引导下 AVNeo 的患者进行了前瞻性分析（N = 7，第 1 组）。对照组为接受标准 AVNeo 技术手术的患者（N = 15，第 2 组）：结果：在第 1 组中，主动脉交叉钳夹时间（70.3 ± 17.0 vs. 91 ± 21.3 分钟，ρ = 0.026）和分流时间（92.9 ± 21.0 vs. 123 ± 24.8 分钟，ρ = 0.011）明显缩短。出院时，第一组的峰值（11.7 ± 2.75 vs. 15.4 ± 4.66 mm Hg，ρ = 0.032）和平均主动脉瓣（AV）梯度（6.29 ± 1.25 vs. 7.87 ± 2.33 mm Hg，ρ = 0.052）均较低。两组患者的平均随访时间均为 49.6 ± 6.9 个月。两组患者均未发生死亡或与瓣膜相关的事件。EchoCG显示，第一组的峰值（10.0 ± 2.65 vs. 12.6 ± 4.05 mm Hg，ρ = 0.090）和平均房室瓣梯度（5.14 ± 1.35 vs. 6.73 ± 2.25 mm Hg，ρ = 0.054）也较低：结论：CT 引导下的 AVNeo 是心脏瓣膜病手术治疗中个性化医疗的典范。结论：CT 引导下的 AVNeo 是心脏瓣膜病手术治疗中个性化医疗的典范，它可以开发出适应患者解剖结构的生物 AV，缩短缺血时间，改善血液动力学。要证明这一概念的可行性，还需要更多的临床观察和更长时间的随访。
A personalized aortic valve replacement using computed tomography-guided aortic valve neocuspidization. Analysis of mid-term results compared to standard Ozaki technique
Background
The original Ozaki technique involves sizing the neovalve cusps during cross-clamp. It leads to prolonging the ischemic time compared to standard surgical AVR. Measurements taken on the collapsed Aortic Root (AR) may also be inaccurate. We use preoperative Computed Tomography (CT) to perform more accurate sizing in physiological conditions and shorten the ischemic time. This study analyzes the results of the CT-guided Aortic Valve Neocuspidization (AVNeo) compared with the Ozaki technique.
Methods
The validity of the concept was evaluated ex vivo. Experimental valves underwent geometric, CT, and hydrodynamic controls. In the clinical phase of the study, we prospectively analyzed patients who received CT-guided AVNeo (N = 7, Group 1). The control group enrolled patients who were operated on after the standard AVNeo technique (N = 15, Group 2).
Results
In Group 1, Aortic Cross-Clamp (70.3 ± 17.0 vs. 91 ± 21.3 min, ρ = 0.026) and Bypass times (92.9 ± 21.0 vs. 123 ± 24.8 min, ρ = 0.011) were significantly shorter. At discharge, the peak (11.7 ± 2.75 vs. 15.4 ± 4.66 mm Hg, ρ = 0.032) and mean Aortic Valve (AV) gradient (6.29 ± 1.25 vs. 7.87 ± 2.33 mm Hg, ρ = 0.052) were lower in Group 1. Only one patient in Group 2 had Aortic Insufficiency (AI) greater than mild. The mean follow-up was 49.6 ± 6.9 months in both groups. There were no late deaths or any valve-related events detected in any patient. EchoCG revealed that peak (10.0 ± 2.65 vs. 12.6 ± 4.05 mm Hg, ρ = 0.090) and mean AV gradient (5.14 ± 1.35 vs. 6.73 ± 2.25 mm Hg, ρ = 0.054) also were lower in Group 1. AI indexes were stable in both Groups.
Conclusions
CT-guided AVNeo is an example of personalized medicine in the surgical treatment of heart valve pathology. It allows the development of a biological AV that adapts to the patient's anatomy, shortens ischemic time, and results in better hemodynamics.
A more significant number of clinical observations and longer follow-up are warranted to prove the viability of the concept.
期刊介绍：
The Journal of Cardiovascular Computed Tomography is a unique peer-review journal that integrates the entire international cardiovascular CT community including cardiologist and radiologists, from basic to clinical academic researchers, to private practitioners, engineers, allied professionals, industry, and trainees, all of whom are vital and interdependent members of our cardiovascular imaging community across the world. The goal of the journal is to advance the field of cardiovascular CT as the leading cardiovascular CT journal, attracting seminal work in the field with rapid and timely dissemination in electronic and print media.
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