Cardiac Computed Tomography Angiography Anatomical Characterization of Patients Screened for a Dedicated Transfemoral Transcatheter Valve System for Primary Aortic Regurgitation

IF 1.4 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Structural Heart Pub Date : 2023-05-01 DOI:10.1016/j.shj.2023.100164
Shawnbir Gogia MD , Torsten P. Vahl MD , Vinod H. Thourani MD , Pradeep K. Yadav MD , Isaac George MD , Susheel K. Kodali MD , Nadira Hamid MD , Lauren Ranard MD , Tiffany Chen MD , Mitsuaki Matsumura BS , Akiko Maehara MD , Hendrik Treede MD, PhD , Stephan Baldus MD , David Daniels MD , Brett C. Sheridan MD , Firas Zahr MD , Mark J. Russo MD, MS , James M. McCabe MD , Stanley J. Chetcuti MD , Martin B. Leon MD , Omar K. Khalique MD
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引用次数: 1

Abstract

Background

Cardiac computed tomography angiography was used to identify anatomical characteristics of the aortic root in patients with severe aortic regurgitation (AR) as compared to those with aortic stenosis (AS) to judge feasibility of transcatheter aortic valve replacement (TAVR) with the JenaValve Trilogy system.

Methods

Cardiac computed tomography angiography was performed prior to planned TAVR for 107 patients with severe AR and 92 patients with severe AS. Measurements related to aortic root and coronary artery anatomy were obtained and compared between groups. Perimeter >90 mm and aortic annulus angle ​>70 degrees were defined as the theoretical exclusion criteria for TAVR. A combination of sinus of Valsalva diameter <30 mm and coronary height <12 mm was defined as high risk for coronary occlusion.

Results

The mean age of patients in the AR group was 74.9 ± 11.2 years, 46% were women, and the mean Society of Thoracic Surgeons risk score for mortality was 3.6 ± 2.1. Comparatively, the mean age of patients in the AS group was 82.3 ± 5.53 years, 65% were women, and the mean Society of Thoracic Surgeonsrisk score was 5.5 ± 3.3. Annulus area, perimeter, diameter, and angle were larger in patients with severe AR. Sinus of Valsalva diameters and heights were larger in patients with severe AR. More AR patients were excluded based on perimeter (14 vs. 2%) and annulus angle (6 vs. 1%). More AS patients exhibited high-risk anatomy for left main coronary occlusion (21 vs. 7%) and right coronary occlusion (14 vs. 3%). The maximum dimension of the ascending aorta was larger in patients with severe AR (39 vs. 35 mm). The percentage of referred AR patients with significant aortopathy requiring surgical intervention was very low (only 1 AR patient with ascending aorta diameter >5.5 cm).

Conclusions

A significantly larger proportion of patients with severe AR are excluded from TAVR as compared to AS due to large aortic annulus size and steep annulus angulation. By far the most prevalent excluding factor is aortic annulus size, with fewer patients excluded due to angulation. AR patients have lower-risk anatomy for coronary occlusion. Larger transcatheter valve sizes and further delivery system modifications are required to treat a larger proportion of AR patients.

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针对原发性主动脉反流筛选专用经股导管瓣膜系统的患者的心脏计算机断层血管造影解剖特征
背景心脏计算机断层扫描血管造影术用于识别严重主动脉瓣反流(AR)患者与主动脉狭窄(as)患者主动脉根部的解剖特征,以判断JenaValve Trilogy系统经导管主动脉瓣置换术(TAVR)的可行性。方法对107例严重AR患者和92例严重AS患者在计划的TAVR前进行心脏计算机断层造影,获得与主动脉根和冠状动脉解剖相关的测量值,并在各组之间进行比较。周长>;90mm和主动脉瓣环角度​>;70度被定义为TAVR的理论排除标准。Valsalva直径<;30mm和冠状动脉高度<;12mm被定义为冠状动脉闭塞的高风险。结果AR组患者的平均年龄为74.9±11.2岁,46%为女性,胸科医生协会的平均死亡率风险评分为3.6±2.1。相比之下,AS组患者的平均年龄为82.3±5.53岁,65%为女性,胸科医生协会的平均风险评分为5.5±3.3。严重AR患者的瓣环面积、周长、直径和角度较大。严重AR患者瓦尔萨尔瓦窦的直径和高度较大。根据周长(14vs.2%)和瓣环角度(6vs.1%),排除了更多的AR患者。更多的AS患者表现出左主冠状动脉闭塞(21%对7%)和右冠状动脉闭塞的高危解剖结构(14%对3%)。严重AR患者的升主动脉最大尺寸较大(39 mm对35 mm)。需要手术干预的具有显著主动脉病变的AR患者的转诊百分比非常低(只有1名AR患者的升主动脉直径>5.5cm)。结论与as相比,严重AR患者被排除在TAVR之外的比例明显更大,这是由于主动脉瓣环大小大和瓣环角度陡峭。到目前为止,最普遍的排除因素是主动脉瓣环大小,由于成角而排除的患者较少。AR患者冠状动脉闭塞的解剖结构风险较低。需要更大的经导管瓣膜尺寸和进一步的输送系统改造来治疗更大比例的AR患者。
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来源期刊
Structural Heart
Structural Heart Medicine-Cardiology and Cardiovascular Medicine
CiteScore
1.60
自引率
0.00%
发文量
81
期刊最新文献
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