{"title":"Morphological Characteristics Following Self-Expanding Transcatheter Heart Valve Implantation and Implications for Hypoattenuating Leaflet Thickening.","authors":"Wence Shi, Guannan Niu, Dejing Feng, Xiangming Hu, Can Wang, Zhenyan Zhao, Hongliang Zhang, Moyang Wang, Yongjian Wu","doi":"10.1002/ccd.31364","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Hypoattenuating leaflet thickening (HALT) following transcatheter aortic valve replacement (TAVR) may compromise valve durability, posing a significant barrier to the broader adoption of this technology among younger patients. Self-expanding valves (SEVs) are the most commonly used transcatheter heart valves (THVs) among Chinese patients with aortic stenosis. Understanding the potential mechanisms underlying HALT is, therefore, critical to guide future THV design and development.</p><p><strong>Aims: </strong>Identify morphological factors associated with HALT Unidentified after SEVs implantation.</p><p><strong>Methods: </strong>This study included 195 consecutive patients from Fuwai Hospital who underwent TAVR with SEVs. All participants underwent their first postoperative 4D-CT scan within 6 months of the procedure. Key parameters following THV implantation were measured and recorded using 3mensio software. Univariate and multivariable logistic regression models were applied to identify associations between variables and HALT. Discriminatory ability was assessed using receiver operating characteristic (ROC) analysis, followed by bootstrap validation for model robustness.</p><p><strong>Results: </strong>HALT was observed in 36.4% of patients (71 out of 195 patients). New sinus height (NSH) and leaflet outflow area were identified as independent risk factors for HALT. The areas under the curve (AUC) for NSH and leaflet outflow area were 0.689 (95% CI: 0.612-0.767) and 0.602 (95% CI: 0.521-0.683), respectively, with no significant difference between them (p = 0.082). Bootstrap validation confirmed the robustness of both NSH and leaflet outflow area, showing performance comparable to the initial stepwise model.</p><p><strong>Conclusion: </strong>NSH and leaflet outflow area were identified as critical post-THV implantation parameters associated with HALT in TAVR patients treated with SEVs. These findings provide valuable insights that could inform the future design and optimization of SEVs.</p>","PeriodicalId":9650,"journal":{"name":"Catheterization and Cardiovascular Interventions","volume":" ","pages":""},"PeriodicalIF":2.1000,"publicationDate":"2024-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Catheterization and Cardiovascular Interventions","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1002/ccd.31364","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
引用次数: 0
Abstract
Background: Hypoattenuating leaflet thickening (HALT) following transcatheter aortic valve replacement (TAVR) may compromise valve durability, posing a significant barrier to the broader adoption of this technology among younger patients. Self-expanding valves (SEVs) are the most commonly used transcatheter heart valves (THVs) among Chinese patients with aortic stenosis. Understanding the potential mechanisms underlying HALT is, therefore, critical to guide future THV design and development.
Aims: Identify morphological factors associated with HALT Unidentified after SEVs implantation.
Methods: This study included 195 consecutive patients from Fuwai Hospital who underwent TAVR with SEVs. All participants underwent their first postoperative 4D-CT scan within 6 months of the procedure. Key parameters following THV implantation were measured and recorded using 3mensio software. Univariate and multivariable logistic regression models were applied to identify associations between variables and HALT. Discriminatory ability was assessed using receiver operating characteristic (ROC) analysis, followed by bootstrap validation for model robustness.
Results: HALT was observed in 36.4% of patients (71 out of 195 patients). New sinus height (NSH) and leaflet outflow area were identified as independent risk factors for HALT. The areas under the curve (AUC) for NSH and leaflet outflow area were 0.689 (95% CI: 0.612-0.767) and 0.602 (95% CI: 0.521-0.683), respectively, with no significant difference between them (p = 0.082). Bootstrap validation confirmed the robustness of both NSH and leaflet outflow area, showing performance comparable to the initial stepwise model.
Conclusion: NSH and leaflet outflow area were identified as critical post-THV implantation parameters associated with HALT in TAVR patients treated with SEVs. These findings provide valuable insights that could inform the future design and optimization of SEVs.
期刊介绍：
Catheterization and Cardiovascular Interventions is an international journal covering the broad field of cardiovascular diseases. Subject material includes basic and clinical information that is derived from or related to invasive and interventional coronary or peripheral vascular techniques. The journal focuses on material that will be of immediate practical value to physicians providing patient care in the clinical laboratory setting. To accomplish this, the journal publishes Preliminary Reports and Work In Progress articles that complement the traditional Original Studies, Case Reports, and Comprehensive Reviews. Perspective and insight concerning controversial subjects and evolving technologies are provided regularly through Editorial Commentaries furnished by members of the Editorial Board and other experts. Articles are subject to double-blind peer review and complete editorial evaluation prior to any decision regarding acceptability.
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