Heart Center, Segeberger Kliniken, Bad Segeberg, Germany; Department of Cardiology, Al-Azhar University, Cairo, Egypt; Cardiology Department, the Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
Heart Center, Segeberger Kliniken, Bad Segeberg, Germany.
JACC Cardiovasc Interv. 2020 Mar 23;13(6):709-722. doi: 10.1016/j.jcin.2020.01.229.
The authors sought to estimate possible interference of the Medtronic Evolut R/Pro transcatheter heart valve (THV) frame with coronary access using multislice computed tomography (MSCT) data.
Lower-risk patients undergoing transcatheter aortic valve replacement (TAVR) endure a high cumulative risk of coronary events, but coronary access can be challenging.
In 101 patients who received an Evolut R/Pro THV, post-TAVR MSCT (performed at a median of 30 days after TAVR) was used to assess possible interference of the elements of the THV frame with coronary access.
The closest cell of the THV frame vertically aligned with the coronary ostium was located opposite the ostium in 58% and 63%, below the ostium in 22% and 30%, or above the ostium in 20% and 7% of left and right coronary arteries, respectively. The free sinus of Valsalva space between the THV frame and the coronary ostium was 0.45 ± 0.17 cm and 0.44 ± 0.17 cm for the left and right coronary arteries, respectively, and showed a stepwise decrease with decreasing THV size (p < 0.001). Bioprosthetic valve commissures were antianatomic (i.e., not aligned with native commissures) in 45 patients (47%), and the commissural post was overlapping a coronary ostium in 15 patients (16%). Two patients (2.0%) had a possible interference of the paravalvular sealing skirt with coronary access.
Using post-TAVR MSCT data, the main mechanism of potential interference of Evolut R/Pro frame with coronary access was an antianatomic commissural post overlapping the coronary ostium.
作者试图使用多层计算机断层扫描（MSCT）数据来评估美敦力 Evolut R/Pro 经导管心脏瓣膜（THV）框架对冠状动脉入路的可能干扰。
接受经导管主动脉瓣置换术（TAVR）的低危患者会承受较高的冠状动脉事件累积风险，但冠状动脉入路可能具有挑战性。
在 101 例接受 Evolut R/Pro THV 的患者中，在 TAVR 后中位数 30 天进行 post-TAVR MSCT，以评估 THV 框架的各个元素与冠状动脉入路可能发生的干扰。
THV 框架垂直对齐的最接近的瓣膜单元位于左、右冠状动脉的 58%和 63%的冠状动脉口对侧，22%和 30%位于冠状动脉口下方，20%和 7%位于冠状动脉口上方。THV 框架与冠状动脉口之间的游离窦状间隙的空间为 0.45 ± 0.17cm 和 0.44 ± 0.17cm，分别用于左、右冠状动脉，且随着 THV 尺寸的减小呈逐步减小（p < 0.001）。生物瓣瓣膜交界处于非解剖位置（即，与原生交界不匹配）的有 45 例患者（47%），而瓣膜交界支柱与冠状动脉口重叠的有 15 例患者（16%）。两名患者（2.0%）的瓣周密封裙边可能与冠状动脉入路发生干扰。
使用 post-TAVR MSCT 数据，Evolut R/Pro 框架与冠状动脉入路发生潜在干扰的主要机制是解剖位置异常的瓣膜交界支柱与冠状动脉口重叠。
