Redo-TAVR中瓣膜扩张的CT和透视分析：首例人体报告。

IF 11.4 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Cardiovascular interventions Pub Date : 2025-08-25 DOI:10.1016/j.jcin.2025.06.017

Parasuram Krishnamoorthy MD , Takayuki Onishi MD , Syed Zaid MD , Stamatios Lerakis MD, PhD , Lucy M. Safi DO , Sahil Khera MD, MPH , Amit Hooda MD , Sunny Goel MD , George D. Dangas MD, PhD , Samin K. Sharma MD , Annapoorna S. Kini MD , Gilbert H.L. Tang MD, MSc, MBA

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引用次数: 0

摘要

背景：重做经导管主动脉瓣置换术（TAVR）治疗TAV衰竭正变得越来越普遍。虽然短期结果似乎是有利的，但没有进行重新tavr成像来评估框架的扩展和几何形状。目的：我们报告了我们人类首次使用多探测器计算机断层扫描（MDCT）和x线透视来评估指数和第二TAV的瓣膜架扩张和几何形状。方法：从2023年1月至2025年4月，连续40例因生物假体瓣膜衰竭而接受redo-TAVR的患者中，有30例术后MDCT可评估。指数TAV预扩张80%(24/30)，所有病例均为后扩张TAV，以优化框架。通过MDCT和x线透视测量不同水平的第一级和第二级TAV的框架尺寸。通过将观察到的测量值与先前研究验证的期望标称测量值进行比较，计算出阀门膨胀和偏心。结果：TAV-in-TAV组合为：8/30 (26.7%)short-in-short, 16/30 (53.3%) short-in-tall (Evolut 15, Navitor 1), 6/30 (20%) tall-in-short。阀门结构劣化是常见的失效机理。MDCT和x线检查均显示指数tav扩张不足，所有病例在重新tavr后均可见扩张。第二种tav在所有阀门类型中都存在膨胀不足的问题，但在高中短（Evolut-in-Sapien）组合中则更为严重。30天没有观察到瓣膜梯度升高和小叶增厚减少。结论：无论瓣膜类型和组合如何，再瓣膜置换术后的指数和第二TAV均存在明显的扩张不足。需要更大规模的研究来验证这一发现，并确定第二TAV扩张不足的长期影响，尽管短期血流动力学表现可接受。

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CT and Fluoroscopic Analyses of Valve Expansion in Redo-TAVR

Background

Redo transcatheter aortic valve replacement (TAVR) for transcatheter aortic valve (TAV) failure is becoming increasingly common. Although short-term outcomes appear favorable, no imaging after redo-TAVR has been performed to evaluate frame expansion and geometry.

Objectives

The authors report a first-in-human experience using multidetector computed tomography (MDCT) and fluoroscopy to evaluate valve frame expansion and geometry of both index and second TAVs.

Methods

From January 2023 to April 2025, 30 of 40 consecutive patients underwent redo-TAVR for bioprosthetic valve failure and had evaluable postprocedural MDCT. Index TAVs were predilated in 80% (24 of 30), and both TAVs were postdilated in all cases for frame optimization. Frame dimensions were measured using MDCT and fluoroscopy for both index and second TAVs at different levels. Valve expansion and eccentricity were calculated by comparing observed measurements with expected nominal measurements validated from previous studies.

Results

TAV-in-TAV combinations were as follows: 8 of 30 (26.7%) short-in-short, 16 of 30 (53.3%) short-in-tall (15 Evolut, 1 Navitor), and 6 of 30 (20%) tall-in-short. Structural valve deterioration was the common mechanism of failure. Both MDCT and fluoroscopy showed that index TAVs were all underexpanded, and expansion was seen after redo-TAVR in all cases. The second TAVs were underexpanded across all valve types, but more so with tall-in-short (Evolut-in-SAPIEN) combination. No elevated valve gradients and no hypoattenuated leaflet thickening were observed at 30 days.

Conclusions

There was significant underexpansion of both index and second TAVs after redo-TAVR, irrespective of valve type and combinations. Larger studies are needed to validate this finding and determine the longer term impact of underexpansion of the second TAV, despite acceptable short-term hemodynamic performance.

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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.