St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
JACC Cardiovasc Interv. 2013 May;6(5):462-8. doi: 10.1016/j.jcin.2012.12.128.
This report sought to study the impact of the balloon-expandable SAPIEN XT (Edwards Lifesciences, Irvine, California) transcatheter heart valve (THV) stent frame geometry and position on outcomes of transcatheter aortic valve replacement (TAVR).
Post-implant THV geometry and position might impact atrioventricular conduction, hemodynamic performance, and annular sealing.
Eighty-nine consecutive patients who underwent TAVR with a Sapien XT THV had pre- and post-implant multidetector computed tomography, transthoracic echocardiography, and electrocardiograms performed to assess THV stent geometry, atrioventricular conduction, and hemodynamic performance.
The THV Circularity (THV eccentricity <10% [eccentricity = minimum stent diameter/maximum stent diameter]) and under-expansion (THV area/nominal THV area <90%) were present in 97.8% (2 of 89) and 0%, respectively. Low THV implantation was associated with new left bundle branch block and complete heart block (3.4 ± 2.0 mm vs. 5.5 ± 2.9 mm, p = 0.01) and with the need for permanent pacemaker implantation (3.5 ± 2.0 mm vs. 7.1 ± 2.5 mm, p = 0.001). In contrast, labeled THV size and THV area oversizing was not associated with atrioventricular conduction disturbances. The relation between inflow stent frame area and annular area was related to paravalvular regurgitation (p = 0.025). Labeled prosthesis size but not prosthesis expansion or eccentricity was related to valve gradient (p = 0.005) and effective orifice area (p < 0.001).
Low implantation depth of balloon-expandable THVs is associated with clinically significant new conduction disturbances and permanent pacemaker implantation. Importantly, annular area oversizing was not associated with these complications.
本研究旨在探讨球囊扩张型 SAPIEN XT（爱德华生命科学公司，加利福尼亚州欧文市）经导管心脏瓣膜（THV）支架框架的几何形状和位置对经导管主动脉瓣置换术（TAVR）结局的影响。
植入后 THV 的几何形状和位置可能会影响房室传导、血液动力学性能和瓣环密封。
89 例连续接受 Sapien XT THV 行 TAVR 的患者分别进行术前和术后多排螺旋 CT、经胸超声心动图和心电图检查，以评估 THV 支架的几何形状、房室传导和血液动力学性能。
THV 的圆度（THV 偏心度＜10%[偏心度=最小支架直径/最大支架直径]）和过度扩张（THV 面积/标称 THV 面积＜90%）分别为 97.8%（89 例中的 2 例）和 0%。低植入深度与新发左束支传导阻滞和完全性心脏阻滞相关（3.4 ± 2.0 mm 比 5.5 ± 2.9 mm，p = 0.01），且与需要植入永久性起搏器相关（3.5 ± 2.0 mm 比 7.1 ± 2.5 mm，p = 0.001）。相比之下，标记的 THV 尺寸和 THV 面积过大与房室传导障碍无关。流入支架框架面积与瓣环面积的关系与瓣周漏相关（p = 0.025）。标记的假体尺寸但不是假体扩张或偏心度与瓣膜梯度（p = 0.005）和有效瓣口面积（p＜0.001）相关。
球囊扩张型 THV 的低植入深度与临床上显著的新发传导障碍和永久性起搏器植入相关。重要的是，瓣环面积过大与这些并发症无关。
