Abstract：
OBJECTIVE: Aortic root replacement requires construction of a composite valve-graft and reimplantation of coronary arteries. This study assessed the feasibility of valve-in-valve transcatheter aortic valve implantation after aortic root replacement.
METHODS: A retrospective review was conducted on 74 consecutive patients who received a composite valve-graft at a single institution from 2019 to 2021. Forty patients had bioprosthetic valves with adequate postoperative gated computed tomographic angiography scans. Computational simulations of balloon and self-expanding transcatheter valve deployments were performed. The modeled coronary distances were compared to traditional, manually measured valve-to-coronary distances.
RESULTS: There was a statistically significant difference in the modeled versus manual measurements of valve to coronary distances were for all patients regardless of valve type or coronary artery analyzed (p <0. 05). Most patients are low risk for coronary obstruction per three-dimensional modeling including those with a valve-to-coronary distance <4 millimeters. Only one patient (2.5%) was at risk for coronary obstruction for the left coronary artery using a ballonvalve. No other valve combination was considered high risk of coronary obstruction. Five patients (12.5%) were at risk for possible valve stent deformation at the outflow, due to angulation at the graft anastomosis.
CONCLUSIONS: Following aortic root replacement, all patients were candidates for Valve-in-Valve using one or both types of transcatheter heart valves. Self-expanding valves may be at higher risk for stent frame deformation at graft anastomotic lines and balloon-expandable valves may be at higher risk of coronary obstruction.
METHODS: A retrospective review was conducted on 74 consecutive patients who received a composite valve-graft at a single institution from 2019 to 2021. Forty patients had bioprosthetic valves with adequate postoperative gated computed tomographic angiography scans. Computational simulations of balloon and self-expanding transcatheter valve deployments were performed. The modeled coronary distances were compared to traditional, manually measured valve-to-coronary distances.
RESULTS: There was a statistically significant difference in the modeled versus manual measurements of valve to coronary distances were for all patients regardless of valve type or coronary artery analyzed (p <0. 05). Most patients are low risk for coronary obstruction per three-dimensional modeling including those with a valve-to-coronary distance <4 millimeters. Only one patient (2.5%) was at risk for coronary obstruction for the left coronary artery using a ballonvalve. No other valve combination was considered high risk of coronary obstruction. Five patients (12.5%) were at risk for possible valve stent deformation at the outflow, due to angulation at the graft anastomosis.
CONCLUSIONS: Following aortic root replacement, all patients were candidates for Valve-in-Valve using one or both types of transcatheter heart valves. Self-expanding valves may be at higher risk for stent frame deformation at graft anastomotic lines and balloon-expandable valves may be at higher risk of coronary obstruction.
摘要：
目的：主动脉根部置换需要构建复合瓣膜移植物和冠状动脉再植。这项研究评估了主动脉根部置换术后经导管瓣瓣下主动脉瓣植入的可行性。
方法：对2019年至2021年在单一机构接受复合瓣膜移植物的74例连续患者进行了回顾性审查。40例患者的生物人工瓣膜具有足够的术后门控计算机断层扫描血管造影扫描。进行了球囊和自膨胀经导管瓣膜展开的计算模拟。将建模的冠状动脉距离与传统的，手动测量瓣膜到冠状动脉的距离。
结果：对于所有患者，无论分析的瓣膜类型或冠状动脉，瓣膜到冠状动脉距离的建模测量值与手动测量值都存在统计学上的显着差异（p<0。05).根据三维建模，大多数患者冠状动脉阻塞的风险较低，包括瓣膜到冠状动脉距离<4毫米的患者。只有一名患者（2.5％）有使用球囊瓣膜的左冠状动脉阻塞的风险。没有其他瓣膜组合被认为是冠状动脉阻塞的高风险。五名患者（12.5％）在流出处可能存在瓣膜支架变形的风险。由于移植物吻合处的角度。
结论：主动脉根部置换后，所有患者均为使用一种或两种类型的经导管心脏瓣膜的患者.自膨胀瓣膜可能在移植物吻合线处支架框架变形的风险较高，而球囊扩张瓣膜可能在冠状动脉阻塞的风险较高。
方法：对2019年至2021年在单一机构接受复合瓣膜移植物的74例连续患者进行了回顾性审查。40例患者的生物人工瓣膜具有足够的术后门控计算机断层扫描血管造影扫描。进行了球囊和自膨胀经导管瓣膜展开的计算模拟。将建模的冠状动脉距离与传统的，手动测量瓣膜到冠状动脉的距离。
结果：对于所有患者，无论分析的瓣膜类型或冠状动脉，瓣膜到冠状动脉距离的建模测量值与手动测量值都存在统计学上的显着差异（p<0。05).根据三维建模，大多数患者冠状动脉阻塞的风险较低，包括瓣膜到冠状动脉距离<4毫米的患者。只有一名患者（2.5％）有使用球囊瓣膜的左冠状动脉阻塞的风险。没有其他瓣膜组合被认为是冠状动脉阻塞的高风险。五名患者（12.5％）在流出处可能存在瓣膜支架变形的风险。由于移植物吻合处的角度。
结论：主动脉根部置换后，所有患者均为使用一种或两种类型的经导管心脏瓣膜的患者.自膨胀瓣膜可能在移植物吻合线处支架框架变形的风险较高，而球囊扩张瓣膜可能在冠状动脉阻塞的风险较高。
