Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, Georgia.
Division of Cardiovascular Medicine, The Ohio State University, Columbus, Ohio.
Ann Thorac Surg. 2020 Oct;110(4):1348-1356. doi: 10.1016/j.athoracsur.2020.02.016. Epub 2020 Mar 14.
This study evaluated the effect of transcatheter aortic valve (TAV)-in-TAV on sinus hemodynamics and washout. With TAV becoming the standard procedure for aortic valve replacement and with the limited valve durability, a second intervention is necessary (TAV-in-TAV) after first TAV failure.
Six arrangements of TAV-in-TAV were chosen for this study as follows: (1) Evolut 23 (Medtronic, Minneapolis, MN) in Evolut 26, (2) Evolut 23 in SAPIEN 3 23 (Edwards Lifesciences, Irvine, CA), (3) Evolut 26 in Evolut 26, (4) Evolut 26 in SAPIEN 23, (5) SAPIEN 3 23 in Evolut 26, and (6) SAPIEN 3 23 in SAPIEN 3 23. These TAV-in-TAV configurations were assessed in a pulse duplicator. Particle image velocimetry was performed.
During systole, (1) the highest velocity was found with SAPIEN-in-SAPIEN (0.7 m/s) and the lowest was with Evolut 26-in-Evolut 26 (0.2 m/s); (2) the highest shear stress magnitude near the leaflet was with Evolut 23-in-SAPIEN (1.45 Pa) and the lowest was with Evolut 26-in-Evolut 26 (0.55 Pa); and (3) washout was almost equal in all sinuses of these cases (<2.5 cycles).
This study shows that TAV-in-TAV is highly dependent on the valve that is originally implanted and the valve to be implanted. Washout is not significantly degraded after TAV-in-TAV compared with valve-in-valve and TAV replacement. Further studies are needed to optimize valve size and selection.
本研究评估了经导管主动脉瓣（TAV）内植入对窦血流动力学和排空的影响。随着 TAV 成为主动脉瓣置换的标准程序，以及瓣膜耐久性有限，在首次 TAV 失败后需要进行第二次干预（TAV 内植入）。
本研究选择了六种 TAV 内植入的布置方式，如下所示：（1）Evolut 23（美敦力，明尼苏达州明尼阿波利斯）植入 Evolut 26，（2）Evolut 23 植入 SAPIEN 3 23（爱德华兹生命科学，加利福尼亚州欧文），（3）Evolut 26 植入 Evolut 26，（4）Evolut 26 植入 SAPIEN 23，（5）SAPIEN 3 23 植入 Evolut 26，（6）SAPIEN 3 23 植入 SAPIEN 3 23。这些 TAV 内植入的布置方式在脉动复制器中进行了评估。进行了粒子图像速度测量。
在收缩期，（1）发现 SAPIEN 内植入的最高速度为 0.7m/s，而 Evolut 26 内植入 Evolut 26 的最低速度为 0.2m/s；（2）在瓣叶附近发现的最高剪切应力幅度为 Evolut 23 植入 SAPIEN（1.45Pa），而 Evolut 26 内植入 Evolut 26 的最低剪切应力幅度为 0.55Pa；（3）所有情况下的窦排空几乎相等（<2.5 个周期）。
本研究表明，TAV 内植入高度依赖于最初植入的瓣膜和要植入的瓣膜。与阀中阀和 TAV 置换相比，TAV 内植入后排空没有明显恶化。需要进一步的研究来优化瓣膜尺寸和选择。
