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

IF 1.4 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Structural Heart 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
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引用次数: 0

摘要

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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New Insights and Perspective on Bioprosthetic Valve Fracture From Bench Testing and Computed Tomography Analysis

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.

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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
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