Cardiology Program, The Prince Charles Hospital, Brisbane, Australia.
EuroIntervention. 2012 Sep;8(5):538-45. doi: 10.4244/EIJV8I5A84.
The clinical value of optimising implant angles during transcatheter aortic valve replacements (TAVR) remains undefined. The Aortic Valve Guide (AVG) is a proprietary software that provides structured analysis of three-dimensional images from rotational angiography (DynaCT). This study compares AVG with preprocedural multislice computed tomography (MSCT) and DynaCT in optimal implant angle prediction for TAVR, and evaluates if an optimised implant angle is associated with reduced paravalvular regurgitation (PVR).
One hundred and six consecutive patients were included, comprising three groups. Group 1 (n=19) underwent no preprocedural MSCT or DynaCT (or AVG); Group 2 (n=44) underwent periprocedural DynaCT, without AVG; Group 3 (n=43) had DynaCT with AVG. Implant angles yielded were graded as excellent, satisfactory or poor. Group 3 were more likely than Groups 2 and 1 to have excellent implant angles (83.7% vs. 52.3% vs. 42.1%, respectively, p=0.001). In 100 patients who had 30-day transthoracic echocardiogram follow-up, an excellent implant angle was significantly more likely to be associated with no PVR than a non-excellent angle (41.3% vs. 21.6%, respectively, p=0.045), independent of operator experience and THV used.
Optimising implant angles may be important in reducing PVR. This is significantly more likely to be achieved with AVG rotational angiography.
在经导管主动脉瓣置换术（TAVR）中优化植入角度的临床价值尚不清楚。Aortic Valve Guide（AVG）是一种专有的软件，可对旋转血管造影（DynaCT）的三维图像进行结构化分析。本研究比较了 AVG 与术前多层螺旋 CT（MSCT）和 DynaCT 在 TAVR 最佳植入角度预测中的作用，并评估了优化的植入角度是否与减少瓣周漏（PVR）有关。
共纳入 106 例连续患者，分为 3 组。第 1 组（n=19）未行术前 MSCT 或 DynaCT（或 AVG）；第 2 组（n=44）行术间 DynaCT，无 AVG；第 3 组（n=43）行 DynaCT 加 AVG。植入角度分为优、良和差。第 3 组与第 2 组和第 1 组相比，植入角度更优的可能性更高（分别为 83.7%、52.3%和 42.1%，p=0.001）。在 100 例接受 30 天经胸超声心动图随访的患者中，与非优角相比，优角与无 PVR 明显相关（分别为 41.3%和 21.6%，p=0.045），与术者经验和使用的 THV 无关。
优化植入角度可能对减少 PVR 很重要。使用 AVG 旋转血管造影可显著提高实现这一目标的可能性。
