Rodríguez-Olivares Ramón, El Faquir Nahid, Rahhab Zouhair, van Gils Lennart, Ren Ben, Sakhi Rafi, Geleijnse Marcel L, van Domburg Ron, de Jaegere Peter P T, Zamorano Gómez Jose L, Van Mieghem Nicolas M
Department of Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands; Department of Cardiology, Ramón y Cajal University Hospital. Madrid, Spain; Centro de Investigación Biomédica en Red Cardiovascular (CIBERCV), Spain.
Department of Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands.
Cardiovasc Revasc Med. 2019 Feb;20(2):126-132. doi: 10.1016/j.carrev.2018.05.004. Epub 2018 May 6.
We sought to evaluate the interaction of different aortic root phenotypes with self-expanding (SEV), balloon-expandable (BEV) and mechanically expanded (MEV) and the impact on significant aortic regurgitation.
We included 392 patients with a SEV (N = 205), BEV (N = 107) or MEV (N = 80). Aortic annulus eccentricity index and calcification were measured by multi-slice CT scan. Paravalvular aortic regurgitation was assessed by contrast aortography (primary analysis) and transthoracic echocardiography (secondary analysis). In mildly calcified roots paravalvular regurgitation incidence was similar for all transcatheter heart valves (SEV 8.4%; BEV 9.1%; MEV 2.0% p = 0.27). Conversely, in heavily calcified roots paravalvular regurgitation incidence was significantly higher with SEV (SEV 45.9%; BEV 0.0%; MEV 0.0% p < 0.001). When paravalvular regurgitation was assessed by TTE, the overall findings were similar although elliptic aortic roots were associated with more paravalvular regurgitation with SEV (20.5% vs. BEV 4.5% vs. MEV 3.2%; p = 0.009).
In heavily calcified aortic roots, significant paravalvular aortic regurgitation is more frequent with SEV than with BEV or MEV, but similar in mildly calcified ones. These findings may support patient-tailored transcatheter heart valve selection.
Aortic stenosis; multislice computed tomography; transcatheter aortic valve replacement; paravalvular aortic regurgitation.
We sought to evaluate the interaction of different aortic root phenotypes with self-expanding (SEV), balloon-expandable (BEV) and mechanically expanded (MEV) and the impact on significant aortic regurgitation. We included 392 patients with a SEV (N = 205), BEV (N = 107) or MEV (N = 80). Aortic annulus eccentricity index and calcification were measured by multi-slice CT scan. Paravalvular aortic regurgitation was assessed by contrast aortography and transthoracic echocardiography. We found that in heavily calcified aortic roots, significant paravalvular aortic regurgitation is more frequent with SEV than with BEV or MEV, but similar in mildly calcified ones.
我们试图评估不同主动脉根部表型与自膨胀式（SEV）、球囊扩张式（BEV）和机械扩张式（MEV）瓣膜之间的相互作用以及对严重主动脉瓣反流的影响。
我们纳入了392例使用SEV（N = 205）、BEV（N = 107）或MEV（N = 80）瓣膜的患者。通过多层CT扫描测量主动脉瓣环偏心指数和钙化情况。通过造影主动脉造影（主要分析）和经胸超声心动图（次要分析）评估瓣周主动脉瓣反流。在轻度钙化的根部，所有经导管心脏瓣膜的瓣周反流发生率相似（SEV为8.4%；BEV为9.1%；MEV为2.0%，p = 0.27）。相反，在重度钙化的根部，SEV的瓣周反流发生率显著更高（SEV为45.9%；BEV为0.0%；MEV为0.0%，p < 0.001）。当通过经胸超声心动图评估瓣周反流时，总体结果相似，尽管椭圆形主动脉根部与SEV的瓣周反流更多相关（20.5%对比BEV的4.5%对比MEV的3.2%；p = 0.009）。
在重度钙化的主动脉根部，SEV导致的严重瓣周主动脉瓣反流比BEV或MEV更常见，但在轻度钙化的根部相似。这些发现可能支持根据患者情况定制经导管心脏瓣膜的选择。
主动脉瓣狭窄；多层计算机断层扫描；经导管主动脉瓣置换术；瓣周主动脉瓣反流。
我们试图评估不同主动脉根部表型与自膨胀式（SEV）、球囊扩张式（BEV）和机械扩张式（MEV）瓣膜之间的相互作用以及对严重主动脉瓣反流的影响。我们纳入了392例使用SEV（N = 205）、BEV（N = 107）或MEV（N = 80）瓣膜的患者。通过多层CT扫描测量主动脉瓣环偏心指数和钙化情况。通过造影主动脉造影和经胸超声心动图评估瓣周主动脉瓣反流。我们发现，在重度钙化的主动脉根部，SEV导致的严重瓣周主动脉瓣反流比BEV或MEV更常见，但在轻度钙化的根部相似。
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