{"title":"经导管主动脉瓣置换术后新窦冲洗时间与血流动力学结果","authors":"Shivabalan Kathavarayan Ramu MD , Toshiaki Isogai MD, MPH , Saksham Beotra MS , Vishwum Kapadia , Nikita Thakore , Ankit Agrawal MD , Shashank Shekhar MD , Maryam Muhammad Ali Majeed-Saidan MD , Rohan Prasad MD , Agam Bansal MD , Abdelrahman Abushouk MD , Odette Iskandar MD , Larisa G. Tereshchenko MD, PhD , Grant Reed MD , Rishi Puri MD, PhD , James Yun MD , Serge Harb MD , Rhonda Miyasaka MD , Zoran Popovic MD , Amar Krishnaswamy MD , Samir R. Kapadia MD","doi":"10.1016/j.shj.2025.100686","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>Leaflet thrombosis and transcatheter heart valve dysfunction are key concerns following transcatheter aortic valve replacement (TAVR). Prolonged neo-sinus washout time (NWT) may predispose patients to hypoattenuated leaflet thickening (HALT) and leaflet thrombosis, increasing the risk of valve degeneration. This study evaluates the association between in vivo NWT derived from aortograms using computer vision and hemodynamic outcomes at 30 days and 1 year post-TAVR.</div></div><div><h3>Methods</h3><div>We retrospectively analyzed 2254 patients (mean age: 79 ± 9 years, 40% female) who underwent TAVR with balloon-expandable valves between 2016 and 2020. Patients were tertile stratified into tertile 1 (T1) (1.444-1.870 s; n = 752), T2 (1.870-1.939 s; n = 752), and T3 (1.939-2.110 s; n = 751) based on their NWTs.</div></div><div><h3>Results</h3><div>At 30 days, T3 had a higher transvalvular aortic valve mean gradient than T1 (12.61 ± 5.07 mmHg vs. 11.98 ± 4.75 mmHg, <em>p</em> = 0.03). In multivariate modeling, T3 was significantly associated with increased aortic valve mean gradient compared to T1 (estimate: 0.703, <em>p</em> = 0.02). NWT was higher in patients with HALT at 30 days (1.970 ± 0.047 s vs. 1.889 ± 0.100 s, <em>p</em> = 0.001), with each 0.1 second increase in NWT tripling the odds of HALT.</div></div><div><h3>Conclusions</h3><div>Prolonged NWT is associated with higher transvalvular gradients and independently predicts HALT post-TAVR. NWT may serve as a novel marker to identify patients at risk of valve dysfunction and guide early pharmacotherapy.</div></div>","PeriodicalId":36053,"journal":{"name":"Structural Heart","volume":"9 9","pages":"Article 100686"},"PeriodicalIF":2.8000,"publicationDate":"2025-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Neo-Sinus Washout Time Following Transcatheter Aortic Valve Replacement and Hemodynamic Outcomes\",\"authors\":\"Shivabalan Kathavarayan Ramu MD , Toshiaki Isogai MD, MPH , Saksham Beotra MS , Vishwum Kapadia , Nikita Thakore , Ankit Agrawal MD , Shashank Shekhar MD , Maryam Muhammad Ali Majeed-Saidan MD , Rohan Prasad MD , Agam Bansal MD , Abdelrahman Abushouk MD , Odette Iskandar MD , Larisa G. Tereshchenko MD, PhD , Grant Reed MD , Rishi Puri MD, PhD , James Yun MD , Serge Harb MD , Rhonda Miyasaka MD , Zoran Popovic MD , Amar Krishnaswamy MD , Samir R. Kapadia MD\",\"doi\":\"10.1016/j.shj.2025.100686\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><div>Leaflet thrombosis and transcatheter heart valve dysfunction are key concerns following transcatheter aortic valve replacement (TAVR). Prolonged neo-sinus washout time (NWT) may predispose patients to hypoattenuated leaflet thickening (HALT) and leaflet thrombosis, increasing the risk of valve degeneration. This study evaluates the association between in vivo NWT derived from aortograms using computer vision and hemodynamic outcomes at 30 days and 1 year post-TAVR.</div></div><div><h3>Methods</h3><div>We retrospectively analyzed 2254 patients (mean age: 79 ± 9 years, 40% female) who underwent TAVR with balloon-expandable valves between 2016 and 2020. Patients were tertile stratified into tertile 1 (T1) (1.444-1.870 s; n = 752), T2 (1.870-1.939 s; n = 752), and T3 (1.939-2.110 s; n = 751) based on their NWTs.</div></div><div><h3>Results</h3><div>At 30 days, T3 had a higher transvalvular aortic valve mean gradient than T1 (12.61 ± 5.07 mmHg vs. 11.98 ± 4.75 mmHg, <em>p</em> = 0.03). In multivariate modeling, T3 was significantly associated with increased aortic valve mean gradient compared to T1 (estimate: 0.703, <em>p</em> = 0.02). NWT was higher in patients with HALT at 30 days (1.970 ± 0.047 s vs. 1.889 ± 0.100 s, <em>p</em> = 0.001), with each 0.1 second increase in NWT tripling the odds of HALT.</div></div><div><h3>Conclusions</h3><div>Prolonged NWT is associated with higher transvalvular gradients and independently predicts HALT post-TAVR. NWT may serve as a novel marker to identify patients at risk of valve dysfunction and guide early pharmacotherapy.</div></div>\",\"PeriodicalId\":36053,\"journal\":{\"name\":\"Structural Heart\",\"volume\":\"9 9\",\"pages\":\"Article 100686\"},\"PeriodicalIF\":2.8000,\"publicationDate\":\"2025-06-21\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Structural Heart\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S2474870625002787\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"CARDIAC & CARDIOVASCULAR SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Structural Heart","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2474870625002787","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
引用次数: 0
摘要
背景：小叶血栓形成和经导管心脏瓣膜功能障碍是经导管主动脉瓣置换术（TAVR）后的关键问题。延长新窦冲洗时间（NWT）可能使患者易发生小叶减薄增厚（HALT）和小叶血栓形成，增加瓣膜退变的风险。本研究评估了tavr术后30天和1年，计算机视觉主动脉造影显示的体内NWT与血流动力学结果之间的关系。方法回顾性分析2016年至2020年期间接受球囊扩张瓣膜TAVR的2254例患者（平均年龄79±9岁，女性40%）。根据患者的NWTs分为T1组（1.444 ~ 1.870 s, n = 752）、T2组（1.870 ~ 1.939 s, n = 752）和T3组（1.939 ~ 2.110 s, n = 751）。结果30 d时，T3组经瓣主动脉瓣平均梯度高于T1组（12.61±5.07 mmHg vs. 11.98±4.75 mmHg, p = 0.03）。在多变量模型中，与T1相比，T3与主动脉瓣平均梯度增加显著相关（估计：0.703,p = 0.02）。30天时，HALT患者的NWT更高（1.970±0.047 s vs 1.889±0.100 s, p = 0.001）， NWT每增加0.1秒，发生HALT的几率增加三倍。结论延长的NWT与较高的经瓣梯度相关，独立预测tavr后HALT。NWT可以作为一种新的标志物来识别有瓣膜功能障碍风险的患者，并指导早期药物治疗。
Neo-Sinus Washout Time Following Transcatheter Aortic Valve Replacement and Hemodynamic Outcomes
Background
Leaflet thrombosis and transcatheter heart valve dysfunction are key concerns following transcatheter aortic valve replacement (TAVR). Prolonged neo-sinus washout time (NWT) may predispose patients to hypoattenuated leaflet thickening (HALT) and leaflet thrombosis, increasing the risk of valve degeneration. This study evaluates the association between in vivo NWT derived from aortograms using computer vision and hemodynamic outcomes at 30 days and 1 year post-TAVR.
Methods
We retrospectively analyzed 2254 patients (mean age: 79 ± 9 years, 40% female) who underwent TAVR with balloon-expandable valves between 2016 and 2020. Patients were tertile stratified into tertile 1 (T1) (1.444-1.870 s; n = 752), T2 (1.870-1.939 s; n = 752), and T3 (1.939-2.110 s; n = 751) based on their NWTs.
Results
At 30 days, T3 had a higher transvalvular aortic valve mean gradient than T1 (12.61 ± 5.07 mmHg vs. 11.98 ± 4.75 mmHg, p = 0.03). In multivariate modeling, T3 was significantly associated with increased aortic valve mean gradient compared to T1 (estimate: 0.703, p = 0.02). NWT was higher in patients with HALT at 30 days (1.970 ± 0.047 s vs. 1.889 ± 0.100 s, p = 0.001), with each 0.1 second increase in NWT tripling the odds of HALT.
Conclusions
Prolonged NWT is associated with higher transvalvular gradients and independently predicts HALT post-TAVR. NWT may serve as a novel marker to identify patients at risk of valve dysfunction and guide early pharmacotherapy.
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