未经评估:评估传统的经导管心脏瓣膜(THV)连合对准技术对经导管主动脉瓣置换术(TAVR)后的THV/冠状动脉重叠和冠状动脉通路(CA)的影响。
UNASSIGNED:在三尖瓣主动脉解剖结构中,特定的EvolutPro/Pro+和AccurateNeo2THV取向与冠状动脉口的新连合重叠减少相关。尚未研究标准定向技术在BAV解剖结构中是否也有效。
UNASSIGNED:DAVINCI(biCuspId主动脉瓣的跨导管主动脉瓣的定义)先导研究是一项前瞻性注册研究,招募连续患有严重BAV狭窄的患者,这些患者正在接受TAVR,最后一代超环形高框架THV植入基于尖端重叠视图的连合对齐。患者接受了TAVR前后计算机断层扫描(CT)和冠状动脉造影。研究终点是有利的THV/冠状动脉重叠率,定义为THV连合桩与冠状动脉口之间的角度>40°。其他终点是成功的THV相对于raphe和TAVR后选择性CA的对齐率。此外,测试了不同的虚拟THV比对模型,以确定哪一种会产生较低程度的THV/冠状动脉重叠.
UNASSIGNED:包括接受TAVR的1型BAV患者(23例使用EvolutPro/Pro+,11例使用AcuateNeo2)。在TAVRCT之前,在50%的患者中发现了中度/重度尖点不对称,在RCA中观察到47.1%的严重冠状动脉口偏心与LCA为8.8%(P<0.007)。29例达到正确的TVH取向。在后TAVRCT,在86.2%中观察到最佳THV对齐/轻度不对齐,但与冠状动脉的中度/重度重叠,RCA为13.7%,LCA为44.8%(P=0.019).在TAVR之后,选择性RCA插管的可能性为82.8%vs.LCA为75.9%(P=0.74),而两个冠状动脉的联合选择性CA在不到三分之二的患者中是可能的。在冠状动脉口重叠视图中的虚拟THV对准(假定假想的圆形THV扩张)将在几乎90%的病例中产生最佳THV/冠状动脉重叠。
UNASSIGNED:考虑到BAV的尖点不对称性和冠状动脉口偏心性,以及潜在的THV不对称扩张,与三尖瓣主动脉瓣狭窄相比,传统连合对准技术与高THV错位率和中度/重度新连合与冠状动脉口重叠率相关。导致TAVR后选择性CA的发生率较低。在BAV患者中,基于冠状动脉口重叠视图的改良THV定向技术可能更可取。
UNASSIGNED: To assess the impact of conventional transcatheter heart valve (THV) commissural alignment techniques on THV/coronary overlap and coronary access (CA) after transcatheter aortic valve replacement (TAVR) in bicuspid aortic valve (BAV).
UNASSIGNED: Specific Evolut Pro/Pro + and Acurate Neo2 THV orientations are associated with reduced neo-commissural overlap with coronary ostia in tricuspid aortic anatomy. Whether standard orientation techniques are effective also in the setting of BAV anatomy has not been studied.
UNASSIGNED: The DA VINCI (Definition of trAnscatheter aortic Valve orIeNtation in biCuspId aortic valve) pilot
study is a prospective registry enrolling consecutive patients with severe BAV stenosis undergoing TAVR with last generation supra-annular tall-frame THVs implanted with a cusp overlap view-based commissural alignment. Patients underwent pre- and post-TAVR computed tomography (CT) and coronary angiography. The
study endpoint was the rate of favorable THV/coronary overlap, defined as an angle > 40° between the THV commissural post and coronary ostia. Other endpoints were the rates of successful THV alignment with respect to the raphe and of selective CA after TAVR. Moreover, different virtual THV alignment models were tested to identify which one would produce the lower degree of THV/coronary overlap.
UNASSIGNED: Thirty-four patients with type 1 BAV with right-left raphe undergoing TAVR (23 with Evolut Pro/Pro + and 11 with Acurate Neo2) were included. At pre-TAVR CT, moderate/severe cusp asymmetry was found in 50% of patients, severe coronary ostia eccentricity was observed in 47.1% for the RCA vs. 8.8% for the LCA (P < 0.007). Correct TVH orientation was achieved in 29 cases. At post-TAVR CT, optimal THV alignment/mild misalignment to the raphe was observed in 86.2%, but a moderate/severe overlap with the coronaries was seen in 13.7% for the RCA and 44.8% for the LCA (P = 0.019). After TAVR, selective RCA cannulation was possible in 82.8% vs. 75.9% for the LCA (P = 0.74), while combined selective CA of both coronaries was possible in less than two-thirds of the patients. Virtual THV alignment in the coronary ostia overlap view assuming a hypothetical circular THV expansion would produce an optimal THV/coronary overlap in almost 90% of cases.
UNASSIGNED: Given cusp asymmetry and coronary ostia eccentricity of BAV combined with potential THV asymmetrical expansion, conventional commissural alignment techniques are associated with higher rates of THV misalignment and of moderate/severe neo-commissure overlap with the coronary ostia as compared to tricuspid aortic stenosis, resulting in lower rates of selective CA after TAVR. A modified THV orientation technique based on the coronary ostia overlap view might be preferable in BAV patients.