Wang M Y, Song G Y, Wang Y, Niu G N, Zhang Q, Zhou Z, Zhang H, Zhang W J, Luo T, Teng S Y, Yang Y J, Wu Y J
Coronary Intervention Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China.
Zhonghua Xin Xue Guan Bing Za Zhi. 2018 Aug 24;46(8):629-634. doi: 10.3760/cma.j.issn.0253-3758.2018.08.010.
To investigate the impact of aortic root morphology on the implantation depth of aortic valve prosthesis during trans-catheter aortic valve replacement (TAVR) in bicuspid aortic valve patients. Clinical data of 40 patients with native bicuspid aortic valve stenosis who underwent TAVR using the self-expandable prosthesis (the Venus A-valve) from 2014 to 2017 in Fuwai Hospital was retrospectively analyzed. The patients were divided into non-deep implantation group (implant depth ≤10 mm by instant angiogram after implantation,29 cases) and deep implantation group (implant depth> 10 mm by instant angiogram after implantation,11 cases).Pre-procedural aortic root characteristics (e.g. calcification, angle and dimensions) were assessed by CT. The impact of aortic root morphology on the implantation depth and clinical outcomes were also evaluated. The age was (75.1±5.9) years with equal representation from the raphe-type and non-raphe type (52.5%(21/40) and 47.5%(19/40)).The bigger aorta angle ((56.5±4.5)° vs. (47.4±9.4)°, 0.004),more frequent mild-calcification (HU850, <200 mm(3)) or severe-calcification(HU850, >1 000 mm(3)) of aortic leaflets (7/11 vs. 4/29, 0.006), as well as higher ratio of left ventricular outflow tract perimeter to annulus perimeter ((109.2±7.5)% vs. (101.5±6.5)%, 0.004) were found in the deep implantation group compared to the non-deep implantation group. The new in-hospital onset of bundle-branchheart-block or atrioventricular block conduction disturbance rate was higher in the deep implantation group than in the non-deep implantation group (6/11 vs. 2/29, 0.030).Left ventricular ejection fraction was similar between deep implantation group and non-deep implantation group at baseline((49.9±8.9)% vs. (55.8±10.4)%, 0.117), and was significantly lower in the deep implantation group than in the non-deep implantation group at 30 days after implantation ((51.6±12.8)% vs. (60.9±8.1)%, 0.020). Aortic root morphology of bicuspid aortic valve patients is associated with implantation depth of the prosthesis during TAVR, which affects the conduction system and left ventricular function during and post TAVR.
探讨二叶式主动脉瓣患者经导管主动脉瓣置换术（TAVR）中主动脉根部形态对主动脉瓣假体植入深度的影响。回顾性分析2014年至2017年在阜外医院接受使用自膨胀式假体（Venus A瓣膜）的TAVR治疗的40例原发性二叶式主动脉瓣狭窄患者的临床资料。将患者分为非深度植入组（植入后即刻血管造影显示植入深度≤10 mm，29例）和深度植入组（植入后即刻血管造影显示植入深度>10 mm，11例）。术前通过CT评估主动脉根部特征（如钙化、角度和尺寸）。还评估了主动脉根部形态对植入深度和临床结局的影响。患者年龄为（75.1±5.9）岁，嵴型和非嵴型比例相当（分别为52.5%（21/40）和47.5%（19/40））。与非深度植入组相比，深度植入组的主动脉角度更大（（56.5±4.5）°对（47.4±9.4）°，P = 0.004），主动脉瓣叶轻度钙化（HU850，<200 mm³）或重度钙化（HU850，>1000 mm³）更频繁（7/11对4/29，P = 0.006），左心室流出道周长与瓣环周长的比值更高（（109.2±7.5）%对（101.5±6.5）%，P = 0.004）。深度植入组住院期间新发束支传导阻滞或房室传导阻滞的发生率高于非深度植入组（6/11对2/29，P = 0.030）。深度植入组和非深度植入组基线时左心室射血分数相似（（49.9±8.9）%对（55.8±10.4）%，P = 0.117），但植入后30天时深度植入组显著低于非深度植入组（（51.6±12.8）%对（60.9±8.1）%，P = 0.020）。二叶式主动脉瓣患者的主动脉根部形态与TAVR期间假体的植入深度相关，这会影响TAVR期间及术后的传导系统和左心室功能。
