{"title":"小主动脉环患者自我扩张与球囊扩张经导管主动脉瓣置换术的血流动力学。","authors":"Takeshi Hamaya, Kiwamu Kamiya, Toshiyuki Nagai, Satonori Tsuneta, Noriko Oyama-Manabe, Hirokazu Komoriyama, Yuki Takahashi, Akinori Takahashi, Yuki Mori, Yoshifumi Mizuguchi, Sakae Takenaka, Suguru Ishizaka, Takuma Sato, Taro Temma, Yasushige Shingu, Kohsuke Kudo, Satoru Wakasa, Toshihisa Anzai","doi":"10.1016/j.cjca.2025.09.046","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>A recent trial showed the supra-annular self-expanding valve (SEV) provides superior valve function compared to the balloon-expandable valve (BEV) in patients with aortic stenosis (AS) and a small aortic annulus (SAA) undergoing transcatheter aortic valve replacement (TAVR). This study aimed to compare blood flow hemodynamics between SEV and BEV using four-dimensional flow cardiovascular magnetic resonance imaging (4D flow CMR).</p><p><strong>Methods: </strong>We prospectively examined 166 consecutive patients with AS who underwent TAVR between May 2018 and March 2025. SAA was defined as an annular area ≤ 430 mm<sup>2</sup>. Patients were categorized into four groups: SAA-SEV (n = 35), SAA-BEV (n = 66), non-SAA-SEV (n = 21), and non-SAA-BEV (n = 44). Blood flow patterns, wall shear stress (WSS), and energy loss were assessed using 4D flow CMR.</p><p><strong>Results: </strong>In patients with SAA, the SEV group showed significantly greater absolute reductions in vortical flow, helical flow, and flow eccentricity after TAVR compared to the BEV group (-0.47 ± 0.9 vs. 0.15 ± 1.0, P = 0.003; -0.79 ± 0.8 vs. -0.36 ± 0.9, P = 0.008; and -0.59 ± 0.9 vs. -0.20 ± 0.8, P = 0.024, respectively). The absolute reduction of average WSS was also significantly greater in the SEV group (-2.0 [-3.0 to -0.9] Pa vs. -0.9 [-2.5 to 0.4] Pa, P = 0.037). These differences were not observed in the non-SAA groups.</p><p><strong>Conclusions: </strong>In SAA patients undergoing TAVR, SEV demonstrated a significantly greater reduction in abnormal blood flow patterns and average WSS than BEV.</p>","PeriodicalId":9555,"journal":{"name":"Canadian Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":5.3000,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Blood Flow Dynamics of Self-Expanding versus Balloon-Expandable Transcatheter Aortic Valve Replacement in Patients with a Small Aortic Annulus.\",\"authors\":\"Takeshi Hamaya, Kiwamu Kamiya, Toshiyuki Nagai, Satonori Tsuneta, Noriko Oyama-Manabe, Hirokazu Komoriyama, Yuki Takahashi, Akinori Takahashi, Yuki Mori, Yoshifumi Mizuguchi, Sakae Takenaka, Suguru Ishizaka, Takuma Sato, Taro Temma, Yasushige Shingu, Kohsuke Kudo, Satoru Wakasa, Toshihisa Anzai\",\"doi\":\"10.1016/j.cjca.2025.09.046\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>A recent trial showed the supra-annular self-expanding valve (SEV) provides superior valve function compared to the balloon-expandable valve (BEV) in patients with aortic stenosis (AS) and a small aortic annulus (SAA) undergoing transcatheter aortic valve replacement (TAVR). This study aimed to compare blood flow hemodynamics between SEV and BEV using four-dimensional flow cardiovascular magnetic resonance imaging (4D flow CMR).</p><p><strong>Methods: </strong>We prospectively examined 166 consecutive patients with AS who underwent TAVR between May 2018 and March 2025. SAA was defined as an annular area ≤ 430 mm<sup>2</sup>. Patients were categorized into four groups: SAA-SEV (n = 35), SAA-BEV (n = 66), non-SAA-SEV (n = 21), and non-SAA-BEV (n = 44). Blood flow patterns, wall shear stress (WSS), and energy loss were assessed using 4D flow CMR.</p><p><strong>Results: </strong>In patients with SAA, the SEV group showed significantly greater absolute reductions in vortical flow, helical flow, and flow eccentricity after TAVR compared to the BEV group (-0.47 ± 0.9 vs. 0.15 ± 1.0, P = 0.003; -0.79 ± 0.8 vs. -0.36 ± 0.9, P = 0.008; and -0.59 ± 0.9 vs. -0.20 ± 0.8, P = 0.024, respectively). The absolute reduction of average WSS was also significantly greater in the SEV group (-2.0 [-3.0 to -0.9] Pa vs. -0.9 [-2.5 to 0.4] Pa, P = 0.037). These differences were not observed in the non-SAA groups.</p><p><strong>Conclusions: </strong>In SAA patients undergoing TAVR, SEV demonstrated a significantly greater reduction in abnormal blood flow patterns and average WSS than BEV.</p>\",\"PeriodicalId\":9555,\"journal\":{\"name\":\"Canadian Journal of Cardiology\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":5.3000,\"publicationDate\":\"2025-10-07\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Canadian Journal of Cardiology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1016/j.cjca.2025.09.046\",\"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":"Canadian Journal of Cardiology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.cjca.2025.09.046","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
Blood Flow Dynamics of Self-Expanding versus Balloon-Expandable Transcatheter Aortic Valve Replacement in Patients with a Small Aortic Annulus.
Background: A recent trial showed the supra-annular self-expanding valve (SEV) provides superior valve function compared to the balloon-expandable valve (BEV) in patients with aortic stenosis (AS) and a small aortic annulus (SAA) undergoing transcatheter aortic valve replacement (TAVR). This study aimed to compare blood flow hemodynamics between SEV and BEV using four-dimensional flow cardiovascular magnetic resonance imaging (4D flow CMR).
Methods: We prospectively examined 166 consecutive patients with AS who underwent TAVR between May 2018 and March 2025. SAA was defined as an annular area ≤ 430 mm2. Patients were categorized into four groups: SAA-SEV (n = 35), SAA-BEV (n = 66), non-SAA-SEV (n = 21), and non-SAA-BEV (n = 44). Blood flow patterns, wall shear stress (WSS), and energy loss were assessed using 4D flow CMR.
Results: In patients with SAA, the SEV group showed significantly greater absolute reductions in vortical flow, helical flow, and flow eccentricity after TAVR compared to the BEV group (-0.47 ± 0.9 vs. 0.15 ± 1.0, P = 0.003; -0.79 ± 0.8 vs. -0.36 ± 0.9, P = 0.008; and -0.59 ± 0.9 vs. -0.20 ± 0.8, P = 0.024, respectively). The absolute reduction of average WSS was also significantly greater in the SEV group (-2.0 [-3.0 to -0.9] Pa vs. -0.9 [-2.5 to 0.4] Pa, P = 0.037). These differences were not observed in the non-SAA groups.
Conclusions: In SAA patients undergoing TAVR, SEV demonstrated a significantly greater reduction in abnormal blood flow patterns and average WSS than BEV.
期刊介绍：
The Canadian Journal of Cardiology (CJC) is the official journal of the Canadian Cardiovascular Society (CCS). The CJC is a vehicle for the international dissemination of new knowledge in cardiology and cardiovascular science, particularly serving as the major venue for Canadian cardiovascular medicine.
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