Ahmad Makhdoum, Muhammed Suleman, Bhavendra Singh, Hatim Al-Raddadi, Leah Wall, Kandace Forsyth, Dominic Parry, Iqbal Jaffer, Ali Alsagheir, Victor Chu, Warkaa Shamkhani, Adel Dyub, Richard Whitlock, Tej Sheth
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Pre- and postoperative gated CT scans were used to measure annular area, sinus of Valsalva (SOV) dimensions, coronary heights, and virtual valve-to-coronary (VTC) and valve-to-sinotubular junction (VTSTJ) distances. High-risk ViV-TAVR anatomy was defined as VTC < 4 mm or VTSTJ < 2 mm. Four enlargement techniques were used (Y-Incision, Manouguian, Nicks and replacement of the coronary sinus).</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>Female patients were more prevalent in the SAVR + ARE group (61% vs. 19.4%, <i>p</i> < 0.001). Preoperatively and compared to the SAVR cohort, SAVR + ARE had a smaller annular area-derived diameter (23 ± 2 mm vs. 26.8 ± 2.2 mm, <i>p</i> < 0.001) and SOV dimensions (28.8 ± 2 vs. 32.8 ± 3.6, <i>p</i> ≤ 0.001) and, both cohorts had coronary heights of ≥ 14 mm. Postoperatively, both groups had a significant reduction in coronary heights by at least 7–9 mm (<i>p</i> < 0.001). On the contrary, the SOV dimension increased significantly by +3 mm in the SAVR + ARE group (< 0.001), while it decreased numerically in the SAVR-only cohort (0.07). Similarly, the majority of both groups were considered low risk for future ViV TAVR (SAVR: 24/31, 74%) and (SAVR + ARE: 22/31, 71%), while 22.6% (7/31) of SAVR and 29% (9/31) of SAVR + ARE were considered anatomically high risk.</p>\n </section>\n \n <section>\n \n <h3> Conclusion</h3>\n \n <p>While most patients who had SAVR, with or without ARE, were anatomically feasible for ViV TAVR, postoperative CT scans identified high-risk anatomy in approximately 25% of cases. Pre- and post-SAVR CT imaging offers insights into surgical planning and lifetime management of aortic valve disease.</p>\n </section>\n </div>","PeriodicalId":15367,"journal":{"name":"Journal of Cardiac Surgery","volume":"2025 1","pages":""},"PeriodicalIF":1.3000,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1155/jocs/9518444","citationCount":"0","resultStr":"{\"title\":\"Feasibility of Transcatheter Aortic Valve Replacement After Surgical Aortic Valve Replacement With and Without Aortic Root Enlargement, Gated CT Study\",\"authors\":\"Ahmad Makhdoum, Muhammed Suleman, Bhavendra Singh, Hatim Al-Raddadi, Leah Wall, Kandace Forsyth, Dominic Parry, Iqbal Jaffer, Ali Alsagheir, Victor Chu, Warkaa Shamkhani, Adel Dyub, Richard Whitlock, Tej Sheth\",\"doi\":\"10.1155/jocs/9518444\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div>\\n \\n <section>\\n \\n <h3> Background</h3>\\n \\n <p>The feasibility of valve-in-valve transcatheter aortic valve replacement (ViV-TAVR) after surgical aortic valve replacement (SAVR) and the impact of aortic root enlargement (ARE) remain unclear. 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引用次数: 0
摘要
手术主动脉瓣置换术（SAVR）后经导管瓣内置换术（ViV-TAVR）的可行性和主动脉根部扩大（ARE）的影响尚不清楚。本研究通过详细的术前和术后门控CT扫描，评估了savr后带ARE和不带ARE的Viv TAVR的解剖学可行性。方法我们分析了2022年9月至2024年5月期间接受SAVR （n = 31）或SAVR + ARE （n = 31）的62例患者。术前和术后门控CT扫描用于测量环形面积，Valsalva窦（SOV）尺寸，冠状动脉高度，虚拟瓣膜到冠状动脉（VTC）和瓣膜到窦管交界处（VTSTJ）的距离。高危ViV-TAVR解剖定义为VTC <； 4mm或VTSTJ <； 2mm。采用了四种扩大技术（y形切口、Manouguian、切口和冠状窦置换术）。结果女性患者在SAVR + ARE组中更为普遍（61%比19.4%,p < 0.001）。术前与SAVR组相比，SAVR + ARE组的环状面积衍生直径更小（23±2mm vs. 26.8±2.2 mm, p < 0.001）， SOV尺寸更小（28.8±2 vs. 32.8±3.6,p≤0.001），两组的冠状动脉高度均≥14 mm。术后两组冠状动脉高度均显著降低至少7 - 9mm （p < 0.001）。相反，在SAVR + ARE组中，SOV尺寸显著增加了+3 mm (< 0.001)，而在仅SAVR组中，SOV尺寸减少了数值（0.07）。同样，两组中大多数人被认为是未来ViV TAVR的低风险（SAVR: 24/31, 74%）和（SAVR + ARE: 22/31, 71%），而22.6%（7/31）的SAVR和29%（9/31）的SAVR + ARE被认为是解剖学上的高风险。结论：虽然大多数SAVR患者，无论有无ARE，在解剖上都是可行的，但术后CT扫描发现约25%的病例存在高危解剖。术前和术后的CT成像为主动脉瓣疾病的手术计划和终身管理提供了见解。
Feasibility of Transcatheter Aortic Valve Replacement After Surgical Aortic Valve Replacement With and Without Aortic Root Enlargement, Gated CT Study
Background
The feasibility of valve-in-valve transcatheter aortic valve replacement (ViV-TAVR) after surgical aortic valve replacement (SAVR) and the impact of aortic root enlargement (ARE) remain unclear. This study assesses the anatomical feasibility of Viv TAVR post-SAVR, with and without ARE through detailed pre- and postoperative gated CT scans.
Methods
We analyzed 62 patients undergoing SAVR (n = 31) or SAVR + ARE (n = 31) between September 2022 and May 2024. Pre- and postoperative gated CT scans were used to measure annular area, sinus of Valsalva (SOV) dimensions, coronary heights, and virtual valve-to-coronary (VTC) and valve-to-sinotubular junction (VTSTJ) distances. High-risk ViV-TAVR anatomy was defined as VTC < 4 mm or VTSTJ < 2 mm. Four enlargement techniques were used (Y-Incision, Manouguian, Nicks and replacement of the coronary sinus).
Results
Female patients were more prevalent in the SAVR + ARE group (61% vs. 19.4%, p < 0.001). Preoperatively and compared to the SAVR cohort, SAVR + ARE had a smaller annular area-derived diameter (23 ± 2 mm vs. 26.8 ± 2.2 mm, p < 0.001) and SOV dimensions (28.8 ± 2 vs. 32.8 ± 3.6, p ≤ 0.001) and, both cohorts had coronary heights of ≥ 14 mm. Postoperatively, both groups had a significant reduction in coronary heights by at least 7–9 mm (p < 0.001). On the contrary, the SOV dimension increased significantly by +3 mm in the SAVR + ARE group (< 0.001), while it decreased numerically in the SAVR-only cohort (0.07). Similarly, the majority of both groups were considered low risk for future ViV TAVR (SAVR: 24/31, 74%) and (SAVR + ARE: 22/31, 71%), while 22.6% (7/31) of SAVR and 29% (9/31) of SAVR + ARE were considered anatomically high risk.
Conclusion
While most patients who had SAVR, with or without ARE, were anatomically feasible for ViV TAVR, postoperative CT scans identified high-risk anatomy in approximately 25% of cases. Pre- and post-SAVR CT imaging offers insights into surgical planning and lifetime management of aortic valve disease.
期刊介绍：
Journal of Cardiac Surgery (JCS) is a peer-reviewed journal devoted to contemporary surgical treatment of cardiac disease. Renown for its detailed "how to" methods, JCS''s well-illustrated, concise technical articles, critical reviews and commentaries are highly valued by dedicated readers worldwide.
With Editor-in-Chief Harold Lazar, MD and an internationally prominent editorial board, JCS continues its 20-year history as an important professional resource. Editorial coverage includes biologic support, mechanical cardiac assist and/or replacement and surgical techniques, and features current material on topics such as OPCAB surgery, stented and stentless valves, endovascular stent placement, atrial fibrillation, transplantation, percutaneous valve repair/replacement, left ventricular restoration surgery, immunobiology, and bridges to transplant and recovery.
In addition, special sections (Images in Cardiac Surgery, Cardiac Regeneration) and historical reviews stimulate reader interest. The journal also routinely publishes proceedings of important international symposia in a timely manner.
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