采用 320 排多层螺旋 CT 评估 Lotus 经导管主动脉瓣置换术与固有瓣下室间隔主动脉瓣交界处的几何相互作用。

Assessment of the geometric interaction between the Lotus transcatheter aortic valve prosthesis and the native ventricular aortic interface by 320-multidetector computed tomography.

机构信息

MonashHeart, Monash Health, Clayton, Victoria, Australia; and Monash Cardiovascular Research Centre, Department of Medicine (MMC), Monash University, Clayton, Victoria, Australia.

出版信息

JACC Cardiovasc Interv. 2015 Apr 27;8(5):740-9. doi: 10.1016/j.jcin.2015.03.002.

DOI:10.1016/j.jcin.2015.03.002

PMID:25946448

Abstract

OBJECTIVES

This study sought to assess the geometric interaction between the Lotus Valve System transcatheter aortic prosthesis (Boston Scientific, Natick, Massachusetts) and the native aortoventricular interface using multidetector computed tomography (MDCT).

BACKGROUND

The interaction between transcatheter aortic valve prostheses and native anatomy is variable, although potentially predictable. The Lotus transcatheter device uses a novel mechanical means of expansion, the effect of which on native anatomic geometry has not previously been described.

METHODS

Forty patients treated with the Lotus prosthesis were enrolled. The patients underwent 320-MDCT imaging before and after implantation. Prosthesis dimensions and relevant interaction parameters, including circularity and expansion, were assessed. The degree of paraprosthetic regurgitation (PAR) and prosthesis gradient were measured by transthoracic echocardiography at the same time points.

RESULTS

The mean baseline annular eccentricity index (EI) was 0.21 ± 0.06 and left ventricular outflow tract EI was 0.31 ± 0.09. The deployed prostheses had high rates of circularity with a mean EI across all device segments of 0.06 ± 0.04. In noncircular device deployment, an EI >0.1 was identified in 25% of prostheses and was associated with greater native annular eccentricity at baseline compared with circular devices (0.24 ± 0.04 vs. 0.19 ± 0.06; p = 0.01). The median percent of expansion was 97.5 ± 3.8% in the inflow portion of the prosthesis. Twenty-five percent of prostheses were <90% expanded in at least 1 segment with a numerical, but not statistically significant, association between oversizing and underexpansion. No correlation was found between device underexpansion and the mean transprosthesis gradient or between noncircularity and PAR.

CONCLUSIONS

The Lotus prosthesis results in nearly full device expansion and circularization of the native basal plane. Awareness of the anatomic interaction between this unique device and the native architecture may help in the formulation of appropriate device-specific sizing algorithms.

摘要

目的

本研究旨在使用多排螺旋 CT（MDCT）评估 Lotus 经导管主动脉瓣系统（波士顿科学公司，马萨诸塞州纳提克）与天然房室界面之间的几何相互作用。

背景

尽管经导管主动脉瓣假体与天然解剖结构之间的相互作用是多变的，但具有潜在的可预测性。Lotus 经导管装置采用了一种新颖的机械扩张方式，以前尚未描述过这种方式对天然解剖结构几何形状的影响。

方法

纳入 40 例接受 Lotus 假体治疗的患者。这些患者在植入前后均接受了 320-MDCT 成像。评估了假体尺寸和相关的相互作用参数，包括圆度和扩张度。在同一时间点通过经胸超声心动图测量瓣周漏（PAR）和假体梯度。

结果

平均基线瓣环偏心指数（EI）为 0.21 ± 0.06，左心室流出道 EI 为 0.31 ± 0.09。展开后的假体具有很高的圆度，所有装置节段的平均 EI 为 0.06 ± 0.04。在非圆形装置展开的情况下，有 25%的假体的 EI >0.1，与圆形装置相比，基线时的天然瓣环偏心度更大（0.24 ± 0.04 比 0.19 ± 0.06；p=0.01）。假体流入部分的中位数扩张率为 97.5 ± 3.8%。在至少 1 个节段中，有 25%的假体的扩张率<90%，但与过大和扩张不足之间没有统计学意义上的关联。未发现装置扩张不足与平均跨瓣梯度之间或非圆度与 PAR 之间存在相关性。