Mathur Moses, McCabe James M, Aldea Gabriel, Pal Jay, Don Creighton W
Department of Medicine, Division of Cardiology, University of Washington, Seattle, Washington.
Division of Cardiothoracic Surgery, Department of Surgery, University of Washington, Seattle, Washington.
Catheter Cardiovasc Interv. 2018 May 1;91(6):1149-1156. doi: 10.1002/ccd.27190. Epub 2017 Aug 24.
To evaluate overexpanded 29 mm SAPIEN (S3) transcatheter heart valves in patients with aortic annuli area >683 mm .
The largest valve area the 29 mm S3 is specified for is 683 mm . Valve overexpansion has been performed in patients with larger aortic annuli, but data are limited. Moreover, feasibility in areas >740 mm is unknown.
All 29 mm S3 transcatheter aortic valve replacements (TAVR) at a single center over 23-months were retrospectively reviewed. Patients with annulus areas >683 mm were included. Immediate post-TAVR hemodynamics and transthoracic echocardiography (TTE) findings on post-TAVR day-1 and day-30 were recorded.
Of 81 29 mm S3 TAVR cases, 3 (3.7%) met inclusion criteria (patients 1, 2, and 3 had CT-scan derived areas of 748.1 mm , 793 mm , and 787 mm , respectively). Annular eccentricity index ranged from 0.12 to 0.25. All underwent transfemoral TAVR with 29 mm S3 valves overexpanded using +4 mL of contrast. Post-dilatation with +5 mL was performed in patient 2. The average valve shortening was 10.68 mm. On day 1, patients 1 and 2 had trace and mild paravalvular leak (PVL) (respectively), whereas, patient 3 had mild-moderate PVL. Patient 1 was also noted to have trace central AR on day 1. No other central AR was noted. Immediate post-procedure aortic regurgitation (AR) index in patients 1, 2, and 3 was 43, 34, and 33 respectively. At 30 days, AR was completely resolved in patient 1, whereas AR severity in patients 2 and 3 remained similar. No patients had > moderate AR at any point during follow-up. No valve migration or embolization occurred. Patient 1 required a permanent pacemaker. No other major complications were noted. All patients were clinically stable at 30 days.
TAVR using overexpanded 29 mm S3 in valve areas >740 mm (up to 793 mm ) seemed to be safe and feasible in our small series. Further study in a larger series is needed to determine clinical outcomes in this patient population.
评估主动脉瓣环面积>683平方毫米的患者中过度扩张的29毫米SAPIEN（S3）经导管心脏瓣膜。
29毫米S3指定的最大瓣膜面积为683平方毫米。对于主动脉瓣环较大的患者已进行瓣膜过度扩张，但数据有限。此外，在面积>740平方毫米的区域中的可行性尚不清楚。
回顾性分析了单中心23个月内所有29毫米S3经导管主动脉瓣置换术（TAVR）。纳入主动脉瓣环面积>683平方毫米的患者。记录TAVR术后即刻的血流动力学以及术后第1天和第30天的经胸超声心动图（TTE）结果。
在81例29毫米S3 TAVR病例中，3例（3.7%）符合纳入标准（患者1、2和3的CT扫描得出的面积分别为748.1平方毫米、793平方毫米和787平方毫米）。瓣环偏心指数范围为0.12至0.25。所有患者均接受经股动脉TAVR，使用29毫米S3瓣膜并通过注入+4毫升造影剂进行过度扩张。患者2进行了+5毫升的后扩张。瓣膜平均缩短10.68毫米。在第1天，患者1和2分别有微量和轻度瓣周漏（PVL），而患者3有轻度至中度PVL。患者1在第1天还被发现有微量中心性主动脉反流（AR）。未发现其他中心性AR。患者1、2和3术后即刻的主动脉反流（AR）指数分别为43、34和33。在第30天，患者1的AR完全消失，而患者2和3的AR严重程度保持相似。在随访期间，没有患者出现>中度AR。未发生瓣膜移位或栓塞。患者1需要永久起搏器。未发现其他主要并发症。所有患者在30天时临床稳定。
在瓣膜面积>740平方毫米（最大至793平方毫米）的患者中使用过度扩张的29毫米S3进行TAVR在我们的小样本系列中似乎是安全可行的。需要在更大系列中进行进一步研究以确定该患者群体的临床结局。
