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“In Sickness and in Health” "无论疾病还是健康
Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-05-01 DOI: 10.1016/j.shj.2024.100303
Anthony DeMaria MD
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引用次数: 0
AltaValve Atrial Fixation System for the Treatment of Severe Mitral Regurgitation and Mitral Annular Calcification 用于治疗严重二尖瓣反流和二尖瓣环钙化的 AltaValve 心房固定系统
Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-05-01 DOI: 10.1016/j.shj.2024.100294
Philippe Généreux MD , Krzysztof Wróbel MD, PhD , Michael J. Rinaldi MD , Thomas Modine MD, PhD , Vinayak Bapat MD , Vlasis Ninios MD , Paul Sorajja MD

Background

Treatment options for patients with mitral regurgitation (MR) and mitral annular calcification (MAC) are limited. The limitations of current transcatheter mitral valve replacement (TMVR) technologies include high screen failure rates, increased risk of left ventricular outflow tract obstruction, and high residual regurgitation. The aim of this study was to evaluate outcomes of TMVR with the AltaValve system (4C Medical, Maple Grove, MN), a supra-annular TMVR with atrial fixation, in patients with severe MR and moderate or severe MAC.

Methods

Six patients with moderate or severe MAC who were treated with AltaValve TMVR had procedural and mid-term outcomes available.

Results

Technical success was achieved in all patients. Median follow-up was 232 days. At discharge, 80% of patients had none/trace MR, and 20% had mild MR. There was no intraprocedural mortality, device malposition, embolization, or thrombosis. One patient expired 3 days postprocedure due to complications related to the transapical access. All other patients were discharged from the hospital without issues. Echocardiography assessments at 30 days showed complete resolution of MR in all patients, with 1 patient with mild MR and a mean mitral valve gradient of 3.7 ± 1.4 mmHg. All patients were in New York Heart Association Class I/II at 30-day follow-up, showing marked improvement as compared with baseline.

Conclusions

In patients with severe MR and severe MAC, the AltaValve TMVR technology may represent a viable treatment option. The atrial fixation minimizes the risk of left ventricular outflow tract obstruction and potentially expands treatable patients, especially in patients with MAC.

背景二尖瓣反流(MR)和二尖瓣环钙化(MAC)患者的治疗方案有限。目前经导管二尖瓣置换(TMVR)技术的局限性包括筛查失败率高、左心室流出道梗阻风险增加以及残余反流率高。本研究旨在评估重度 MR 和中度或重度 MAC 患者使用 AltaValve 系统(4C Medical,Maple Grove,MN)进行 TMVR 的疗效,AltaValve 系统是一种具有心房固定功能的瓣上 TMVR。中位随访时间为 232 天。出院时,80%的患者无/微量 MR,20%的患者有轻度 MR。术中无死亡、装置错位、栓塞或血栓形成。一名患者在术后 3 天因与经心尖入路相关的并发症而死亡。其他患者均顺利出院。30 天后的超声心动图评估显示,所有患者的 MR 均已完全消除,只有一名患者存在轻度 MR,二尖瓣平均梯度为 3.7 ± 1.4 mmHg。结论 对于严重 MR 和严重 MAC 患者,AltaValve TMVR 技术可能是一种可行的治疗方案。心房固定最大程度地降低了左心室流出道阻塞的风险,并有可能扩大可治疗患者的范围,尤其是对于 MAC 患者。
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引用次数: 0
New Insights and Perspective on Bioprosthetic Valve Fracture From Bench Testing and Computed Tomography Analysis 从台架测试和计算机断层扫描分析中获得生物人工瓣膜断裂的新见解和新视角
Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-05-01 DOI: 10.1016/j.shj.2023.100276
Go Hashimoto MD , Santiago Garcia MD , Hirotomo Sato MD, PhD , Miho Fukui MD, PhD , Muhammad Hammadah MD , Robert Steffen MD , Joao L. Cavalcante MD , Vinayak N. Bapat MD

Background

Bioprosthetic valve fracture (BVF) during valve-in-valve TAVR (transcatheter aortic valve replacement) is a procedural adjunct designed to optimize the expansion of the transcatheter heart valve and reduce patient-prosthesis mismatch by using a high-pressure balloon to intentionally fracture the surgical heart valve (SHV).

Methods

We performed bench testing on 15 bioprosthetic SHV to examine the optimal balloon size and pressure for BVF. We assessed morphological changes and expansion of SHV by computed tomography angiography. Successful BVF was defined as balloon waist disappearance on fluoroscopy and/or sudden pressure drop during balloon inflation.

Results

Nine valves met the definition of BVF, 3 of which were confirmed by disruption of the stent frame. We classified surgical valves into 3 subsets: 1) fracturable with metal stent frame (MSF), 2) fracturable with polymer stent frame (PSF) and 3) nonfracturable. In general, valves with MSF were fractured using a balloon size = true internal diameter plus 3-5 mm inflated at high pressure (16-20 ATM) whereas valves with PSF could be fractured with a balloon size = true internal diameter plus 3-5 mm and lower balloon pressure (6-14 ATM). Gains in computed tomography angiography derived inflow area after BVF were 12.3% for MSF and 3.6% for PSF SHV.

Conclusions

Gains in CT-determined valve area after BVF depend on the physical properties of the SHV, which in turn influences pressure thresholds and balloon sizing strategy for optimal BVF. Elastic recoil of PSF valves limits the gains in inflow area after BVF.

背景在瓣膜置入式 TAVR(经导管主动脉瓣置换术)中进行生物假体瓣膜折断(BVF)是一种手术辅助方法,旨在通过使用高压球囊有意折断手术心脏瓣膜(SHV)来优化经导管心脏瓣膜的扩张并减少患者与假体的不匹配。方法我们对 15 个生物假体 SHV 进行了台架试验,以研究 BVF 的最佳球囊大小和压力。我们通过计算机断层扫描血管造影评估了 SHV 的形态变化和扩张情况。结果 9 个瓣膜符合 BVF 的定义,其中 3 个通过支架框架的破坏得到证实。我们将手术瓣膜分为三个子集:1)金属支架框架(MSF)可断裂瓣膜;2)聚合物支架框架(PSF)可断裂瓣膜;3)不可断裂瓣膜。一般来说,使用球囊尺寸 = 真实内径加 3-5 毫米并在高压(16-20 ATM)下充气可使带有 MSF 的瓣膜断裂,而使用球囊尺寸 = 真实内径加 3-5 毫米并在较低球囊压力(6-14 ATM)下充气可使带有 PSF 的瓣膜断裂。结论 BVF 后 CT 确定的瓣膜面积的增加取决于 SHV 的物理特性,而 SHV 的物理特性反过来又会影响最佳 BVF 的压力阈值和球囊尺寸策略。PSF 瓣膜的弹性反冲限制了 BVF 后流入面积的增加。
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引用次数: 0
A Comparative Study of Transcatheter Aortic Valve Implantation Views for Two Different Self-Expanding Aortic Valves 两种不同自扩张主动脉瓣的经导管主动脉瓣植入视图比较研究
Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-05-01 DOI: 10.1016/j.shj.2024.100281
Vilhelmas Bajoras MD , Ivan Wong MD , Xi Wang MD , Kamilė Čerlinskaitė-Bajorė MD , Gintautas Bieliauskas MD , Ole De Backer MD, PhD
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引用次数: 0
A Simple Technique for Deploying the SENTINEL Cerebral Protection System in Bovine Aortic Arch Anatomy 在牛主动脉弓解剖中部署 SENTINEL 脑保护系统的简单技术
Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-03-01 DOI: 10.1016/j.shj.2023.100228
Ajoe John Kattoor MD, Christopher Manion MD, Vijay Iyer MD, PhD

The SENTINEL Cerebral Protection System is one of the most commonly used devices for embolic protection during transcatheter aortic valve replacement. However, successful deployment of the SENTINEL device is often challenging in patients with a bovine aortic arch anatomy using the standard technique and requires extensive manipulation in the aortic arch increasing the risk of stroke. We describe a novel and simple technique of 2-filter deployment of SENTINEL device in patients with bovine arch anatomy. In this technique, after the deployment of the proximal filter, the device is hyperflexed on itself facing the lateral aspect of the ascending aorta instead of facing the descending aorta, with its tip pointing toward the common origin of the left common carotid artery (LCCA) and brachiocephalic trunk. The guidewire is then advanced to the LCCA. Since the guidewire can pass either anterior or posterior to the device shaft, the device needs to be untwisted either by clockwise or counterclockwise motion, before pulling the device shaft back to engage the LCCA, after which the distal filter can be deployed. Computed tomography scans obtained for planning transcatheter aortic valve replacement should be reviewed for the presence of bovine aortic arch anatomy so that this technique can be deployed directly, thereby reducing manipulations in the aortic arch, saving time, and not requiring additional equipment.

SENTINEL 脑保护系统是经导管主动脉瓣置换术中最常用的栓塞保护装置之一。然而,对于具有牛主动脉弓解剖结构的患者,使用标准技术成功部署 SENTINEL 装置往往具有挑战性,而且需要在主动脉弓上进行大量操作,增加了中风的风险。我们介绍了一种新颖而简单的技术,即在有牛形主动脉弓解剖结构的患者中使用 2 个过滤器部署 SENTINEL 装置。在这种技术中,在部署近端过滤器后,将装置超屈在升主动脉的外侧,而不是降主动脉的外侧,其顶端指向左颈总动脉 (LCCA) 和肱动脉干的共同起源。然后将导丝推进到 LCCA。由于导丝可以从器械轴的前方或后方通过,因此需要通过顺时针或逆时针运动来松开器械,然后再将器械轴拉回以插入 LCCA,之后就可以部署远端过滤器了。在规划经导管主动脉瓣置换术时获得的计算机断层扫描图像应检查是否存在牛主动脉弓解剖结构,以便直接部署该技术,从而减少主动脉弓内的操作,节省时间,并且不需要额外的设备。
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引用次数: 0
Editorial: Real World Transcatheter Edge to Edge Repair Eligibility in HF Patients: Finding the Opportunity 社论:真实世界中高血压患者的经导管边缘修复资格:寻找机会
Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-03-01 DOI: 10.1016/j.shj.2023.100274
Anita W. Asgar MD, MSc, Theofilos Panagiotidis MD
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引用次数: 0
Characteristics and Outcomes of Patients Receiving a Second Rescue Valve During Transcatheter Aortic Valve Implantation 在经导管主动脉瓣植入术中接受第二个救援瓣膜的患者的特征和预后
Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-03-01 DOI: 10.1016/j.shj.2023.100231
Henrik Bjursten MD, PhD , Sasha Koul MD, PhD , Pétur Pétursson MD, PhD , Jacob Odenstedt MD, PhD , Henrik Hagström MD , Jenny Backes MD , Niels Erik Nielsen MD, PhD , Andreas Rück MD, PhD , Jan Johansson MD , Stefan James MD, PhD , Magnus Settergren MD, PhD , Matthias Götberg MD, PhD , Troels Yndigen MD

Background

Transcatheter aortic valve implantation (TAVI) has become a safe procedure. However, complications occur, including uncommon complications such as valve malposition, which requires the implantation of an additional rescue valve (rescue-AV). The aim was to study the occurrence and outcomes of rescue-AV in a nationwide registry.

Methods

The Swedish national TAVI registry was used as the primary data source, where all 6706 TAVI procedures from 2016 to 2021 were retrieved. Nontransfemoral access and planned valve-in-valve were excluded. In total, 79 patients were identified as having had a rescue-AV, and additional detailed data were collected for these patients. This dataset was analyzed for any characteristics that could predispose patients to a rescue-AV. The outcome of patients receiving rescue-AV also was studied.

Results

Of the 5948 patients in the study, 1.3% had a rescue-AV. There were few differences between patients receiving 1 valve and rescue-AV patients. For patients receiving a rescue-AV, the 30-day mortality was 15.2% compared to 1.6% in the control group. A poor outcome after rescue-AV was often associated with a second complication; for example, stroke, need for emergency surgery, or heart failure. Among the patients with rescue-AV who survived at least 30 days, landmark analyses showed similar survival rates compared to the control group.

Conclusions

Among TAVI patients in a nationwide register, rescue-AV occurred in 1.3% of patients. The 30-day mortality in patients receiving rescue-AV was high, but long-term outcome among 30-day survivors was similar to the control group.

背景导管主动脉瓣植入术(TAVI)已成为一种安全的手术。然而,并发症也时有发生,包括瓣膜错位等不常见的并发症,这就需要植入额外的救援瓣膜(救援瓣膜)。瑞典国家 TAVI 登记处作为主要数据来源,检索了 2016 年至 2021 年的 6706 例 TAVI 手术。非经股动脉入路和计划中的瓣内瓣膜被排除在外。总共有 79 名患者被确定为进行了抢救性瓣膜置换术,并收集了这些患者的其他详细数据。我们对该数据集进行了分析,以找出可能导致患者接受抢救性 AV 的任何特征。结果 在研究的 5948 名患者中,有 1.3% 的患者接受了抢救性 AV。接受单瓣手术的患者与接受抢救性单瓣手术的患者之间几乎没有差异。接受抢救性 AV 的患者 30 天死亡率为 15.2%,而对照组为 1.6%。抢救性人工瓣膜术后的不良预后往往与第二种并发症有关,例如中风、需要紧急手术或心力衰竭。在至少存活 30 天的抢救-AV 患者中,地标分析显示其存活率与对照组相似。接受抢救-AV的患者30天死亡率较高,但30天存活患者的长期预后与对照组相似。
{"title":"Characteristics and Outcomes of Patients Receiving a Second Rescue Valve During Transcatheter Aortic Valve Implantation","authors":"Henrik Bjursten MD, PhD ,&nbsp;Sasha Koul MD, PhD ,&nbsp;Pétur Pétursson MD, PhD ,&nbsp;Jacob Odenstedt MD, PhD ,&nbsp;Henrik Hagström MD ,&nbsp;Jenny Backes MD ,&nbsp;Niels Erik Nielsen MD, PhD ,&nbsp;Andreas Rück MD, PhD ,&nbsp;Jan Johansson MD ,&nbsp;Stefan James MD, PhD ,&nbsp;Magnus Settergren MD, PhD ,&nbsp;Matthias Götberg MD, PhD ,&nbsp;Troels Yndigen MD","doi":"10.1016/j.shj.2023.100231","DOIUrl":"10.1016/j.shj.2023.100231","url":null,"abstract":"<div><h3>Background</h3><p>Transcatheter aortic valve implantation (TAVI) has become a safe procedure. However, complications occur, including uncommon complications such as valve malposition, which requires the implantation of an additional rescue valve (rescue-AV). The aim was to study the occurrence and outcomes of rescue-AV in a nationwide registry.</p></div><div><h3>Methods</h3><p>The Swedish national TAVI registry was used as the primary data source, where all 6706 TAVI procedures from 2016 to 2021 were retrieved. Nontransfemoral access and planned valve-in-valve were excluded. In total, 79 patients were identified as having had a rescue-AV, and additional detailed data were collected for these patients. This dataset was analyzed for any characteristics that could predispose patients to a rescue-AV. The outcome of patients receiving rescue-AV also was studied.</p></div><div><h3>Results</h3><p>Of the 5948 patients in the study, 1.3% had a rescue-AV. There were few differences between patients receiving 1 valve and rescue-AV patients. For patients receiving a rescue-AV, the 30-day mortality was 15.2% compared to 1.6% in the control group. A poor outcome after rescue-AV was often associated with a second complication; for example, stroke, need for emergency surgery, or heart failure. Among the patients with rescue-AV who survived at least 30 days, landmark analyses showed similar survival rates compared to the control group.</p></div><div><h3>Conclusions</h3><p>Among TAVI patients in a nationwide register, rescue-AV occurred in 1.3% of patients. The 30-day mortality in patients receiving rescue-AV was high, but long-term outcome among 30-day survivors was similar to the control group.</p></div>","PeriodicalId":36053,"journal":{"name":"Structural Heart","volume":"8 2","pages":"Article 100231"},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2474870623001252/pdfft?md5=d8e7317bcc2e227b6226a3cbf035db7d&pid=1-s2.0-S2474870623001252-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135765403","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Eligibility and Potential Benefit of Transcatheter Edge-to-Edge Repair in a Contemporary Cohort With Heart Failure: Evidence From a Large Integrated Health Care Delivery System 当代心力衰竭患者队列中经导管边缘到边缘修复术的资格和潜在益处:来自大型综合医疗服务系统的证据
Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-03-01 DOI: 10.1016/j.shj.2023.100237
Andrew P. Ambrosy MD , Jingrong Yang MA , Andrew S. Tai MD , Sadia J. Dimbil MD , Elisha A. Garcia BS , Sue Hee Sung MPH , Ankeet S. Bhatt MD, MBA , Matthew D. Solomon MD, PhD , Ivy A. Ku MD, MAS , Jacob M. Mishell MD , Edward J. McNulty MD , Jonathan G. Zaroff MD , Andrew N. Rassi MD , Jeremy Kong MD , Alan S. Go MD

Background

The eligibility and potential benefit of transcatheter edge-to-edge repair (TEER) in addition to guideline-directed medical therapy to treat moderate-severe or severe secondary mitral regurgitation (MR) has not been reported in a contemporary heart failure (HF) population.

Methods

Eligibility for TEER based on Food and Drug Administration (FDA) labeling: (1) HF symptoms, (2) moderate-severe or severe MR, (3) left ventricular ejection fraction (LVEF) 20% to 50%, (4) left ventricular end-systolic dimension 7.0 cm, and (5) receiving GDMT (blocker + angiotensin-converting enzyme inhibitor/angiotensin receptor blocker). The proportion (%) of patients eligible for TEER. The hypothetical number needed to treat to prevent or postpone adverse outcomes was estimated using relative risk reductions from published hazard ratios in the registration trial and the observed event rates.

Results

We identified 50,841 adults with HF and known LVEF. After applying FDA criteria, 2461 patients (4.8%) were considered eligible for transcatheter mitral valve replacement (FDA+), with the vast majority of patients excluded (FDA-) based on a lack of clinically significant MR (N = 47,279). FDA+ patients had higher natriuretic peptide levels and were more likely to have a prior HF hospitalization compared to FDA- patients. Although FDA+ patients had a more dilated left ventricle and lower LVEF, median (25th-75th) left ventricular end-systolic dimension (cm) was low at 4.4 (3.7-5.1) and only 30.8% had severely reduced LVEF. FDA+ patients were at higher risk of HF-related morbidity and mortality. The estimated number needed to treat to potentially prevent or postpone all-cause hospitalization was 4.4, 8.8 for HF hospitalization, and 5.3 for all-cause death at 24 months in FDA+ patients.

Conclusions

There is a low prevalence of TEER eligibility based on FDA criteria primarily due to absence of moderate-severe or severe MR. FDA+ patients are a high acuity population and may potentially derive a robust clinical benefit from TEER based on pivotal studies. Additional research is necessary to validate the scope of eligibility and comparative effectiveness of TEER in real-world populations.

背景在当代心力衰竭(HF)人群中,除指南指导的药物治疗外,经导管边缘到边缘修补术(TEER)治疗中度或重度继发性二尖瓣反流(MR)的资格和潜在益处尚未见报道。方法根据美国食品和药物管理局(FDA)的标签,符合TEER条件的患者包括:(1)有HF症状;(2)中度或重度MR;(3)左室射血分数(LVEF)为20%至50%;(4)左室收缩末期尺寸为7.0厘米;(5)正在接受GDMT(阻滞剂+血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂)治疗。符合 TEER 条件的患者比例(%)。根据注册试验中已公布的危险比和观察到的事件发生率估算出预防或推迟不良结局所需的假定治疗人数。在应用 FDA 标准后,有 2461 名患者(4.8%)被认为符合经导管二尖瓣置换术的条件(FDA+),绝大多数患者(FDA-)被排除在外,原因是缺乏有临床意义的 MR(N = 47279)。与 FDA- 患者相比,FDA+ 患者的钠尿肽水平较高,且更有可能既往接受过心房颤动住院治疗。虽然 FDA+ 患者的左心室更加扩张,LVEF 更低,但左心室收缩末期尺寸(厘米)的中位数(第 25-75 位)较低,为 4.4(3.7-5.1),只有 30.8% 的患者 LVEF 严重降低。FDA+患者的心房颤动相关发病率和死亡率风险较高。在 24 个月内,FDA+ 患者为预防或推迟全因住院所需的估计治疗人数为 4.4 人,HF 住院为 8.8 人,全因死亡为 5.3 人。FDA+ 患者是高敏锐度人群,根据关键性研究,他们可能从 TEER 中获得显著的临床获益。有必要开展更多研究,以验证 TEER 在实际人群中的资格范围和比较效果。
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引用次数: 0
The Limitation of Limitations 限制的限制
Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-03-01 DOI: 10.1016/j.shj.2024.100283
Anthony DeMaria MD
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引用次数: 0
Leaflet Mechanical Stress in Different Designs and Generations of Transcatheter Aortic Valves: An in Vitro Study 不同设计和世代的经导管主动脉瓣的瓣叶机械应力:体外研究
Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-03-01 DOI: 10.1016/j.shj.2023.100262
Viktória Stanová Dipl-Ing, MSc, PhD , Régis Rieu Dipl-Ing, PhD , Lionel Thollon PhD , Erwan Salaun MD, PhD , Josep Rodés-Cabau MD , Nancy Côté PhD , Diego Mantovani Dipl-Ing, PhD , Philippe Pibarot DVM, PhD

Background

It is unknown whether bioprostheses used for transcatheter aortic valve implantation will have similar long-term durability as those used for surgical aortic valve replacement. Repetitive mechanical stress applied to the valve leaflets, particularly during diastole, is the main determinant of structural valve deterioration. Leaflet mechanical stress cannot be measured in vivo. The objective of this in vitro/in silico study was thus to compare the magnitude and regional distribution of leaflet mechanical stress in old vs new generations of self-expanding (SE) vs balloon expandable (BE) transcatheter heart valves (THVs).

Methods

A double activation simulator was used for in vitro testing of two generations of SE THV (Medtronic CoreValve 26 mm and EVOLUT PRO 26 mm) and two generations of BE THV (Edwards SAPIEN 23 mm vs SAPIEN-3 23 mm). These THVs were implanted within a 21-mm aortic annulus. A noncontact system based on stereophotogammetry and digital image correlation with high spatial and temporal resolution (2000 img/sec) was used to visualize the valve leaflet motion and perform the three-dimensional analysis. A finite element model of the valve was developed, and the leaflet deformation obtained from the digital image correlation analysis was applied to the finite element model to calculate local leaflet mechanical stress during diastole.

Results

The maximum von Mises leaflet stress was higher in early vs new THV generation (p < 0.05) and in BE vs SE THV (p < 0.05): early generation BE: 2.48 vs SE: 1.40 MPa; new generation BE: 1.68 vs SE: 1.07 MPa. For both types of THV, the highest values of leaflet stress were primarily observed in the upper leaflet edge near the commissures and to a lesser extent in the mid-portion of the leaflet body, which is the area where structural leaflet deterioration most often occurs in vivo.

Conclusions

The results of this in vitro/in silico study suggest that: i) Newer generations of THVs have ∼30% lower leaflet mechanical stress than the early generations; ii) For a given generation, SE THVs have lower leaflet mechanical stress than BE THVs. Further studies are needed to determine if these differences between new vs early THV generations and between SE vs BE THVs will translate into significant differences in long-term valve durability in vivo.

背景经导管主动脉瓣植入术中使用的生物假体是否具有与外科主动脉瓣置换术中使用的生物假体相似的长期耐久性,目前还不得而知。瓣叶受到的重复机械应力,尤其是在舒张期,是瓣膜结构退化的主要决定因素。瓣叶机械应力无法在体内测量。因此,这项体外/硅学研究的目的是比较新旧两代自扩张(SE)和球囊扩张(BE)经导管心脏瓣膜(THV)瓣叶机械应力的大小和区域分布。方法使用双活化模拟器对两代 SE THV(美敦力 CoreValve 26 毫米和 EVOLUT PRO 26 毫米)和两代 BE THV(Edwards SAPIEN 23 毫米和 SAPIEN-3 23 毫米)进行体外测试。这些 THV 均植入 21 毫米的主动脉瓣环内。使用基于立体摄影测量和数字图像关联的非接触系统,以高空间和时间分辨率(2000 IMG/秒)观察瓣叶运动并进行三维分析。结果 早期 THV 与新一代 THV 相比(p < 0.05),BE THV 与 SE THV 相比(p < 0.05),Von Mises 瓣叶最大应力更高:早期 BE:2.48 MPa,SE:1.40 MPa;新一代 BE:1.68 MPa,SE:1.07 MPa。对于这两种类型的 THV,小叶应力的最高值主要出现在靠近合叶的小叶上缘,其次是小叶体的中间部分,而这正是体内小叶结构退化最常发生的区域。结论这项体外/硅学研究结果表明:i) 新一代 THV 的小叶机械应力比早期 THV 低 30%;ii) 在给定的一代中,SE THV 的小叶机械应力比 BE THV 低。需要进一步研究来确定新一代 THV 与早期 THV 之间以及 SE THV 与 BE THV 之间的这些差异是否会转化为体内瓣膜长期耐久性的显著差异。
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引用次数: 0
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Structural Heart
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