Ben-Shoshan Jeremy, Alosaimi Hind, Lauzier Pascal Thériault, Pighi Michele, Talmor-Barkan Yeela, Overtchouk Pavel, Martucci Giuseppe, Spaziano Marco, Finkelstein Ariel, Gada Hemal, Piazza Nicolo
McGill University Health Centre, McGill University, Montreal, Quebec, Canada; Tel-Aviv Medical Center, Tel-Aviv University, Tel-Aviv, Israel.
McGill University Health Centre, McGill University, Montreal, Quebec, Canada.
JACC Cardiovasc Interv. 2021 Jan 25;14(2):185-194. doi: 10.1016/j.jcin.2020.10.033.
The purpose of this study was to assess the concordance between transcatheter aortic valve implantation angles generated by the "double S-curve" and "cusp-overlap" techniques.
The "double S-curve" and "cusp-overlap" methods aim to define optimal fluoroscopic projections for transcatheter aortic valve replacement (TAVR) with a self-expandable device.
The study included 100 consecutive patients undergoing TAVR with self-expanding device planned by multidetector computed tomography. TAVR was performed using the double S-curve model, as a view in which both the aortic valve annulus and delivery catheter planes are displayed perpendicularly on fluoroscopy. Optimal projection according to the cusp-overlap technique was retrospectively generated by overlapping the right and left cups on the multidetector computed tomography annular plane. The angular difference between methods was assessed in spherical 3 dimensions and on the left and right anterior oblique (RAO) and cranial and caudal (CAU) axes.
The double S-curve and cusp-overlap methods provided views located in the same quadrant, mostly the RAO and CAU, in 92% of patients with a median 3-dimensional angular difference of 10.0° (interquartile range: 5.5° to 17.9°). The 3-dimensional deviation between the average angulation obtained by each method was not statistically significant (1.49°; p = 0.349). No significant differences in average coordinates were noted between the double S-curve and cusp-overlap methods (RAO: 14.7 ± 15.2 vs. 12.9 ± 12.5; p = 0.36; and CAU: 27.0 ± 9.4 vs. 26.9 ± 10.4; p = 0.90). TAVR using the double S-curve was associated with 98% device success, low complication rate, and absence of moderate-to-severe paravalvular leak.
The double S-curve and cusp-overlap methods provide comparable TAVR projections, mostly RAO and CAU. TAVR using the double S-curve model is associated with a high rate of device success and low rate of procedural complications.
本研究旨在评估“双 S 曲线”和“瓣叶重叠”技术所产生的经导管主动脉瓣植入角度之间的一致性。
“双 S 曲线”和“瓣叶重叠”方法旨在为使用自膨胀装置的经导管主动脉瓣置换术（TAVR）确定最佳透视投影。
本研究纳入了 100 例连续接受使用自膨胀装置的 TAVR 治疗的患者，这些患者均通过多排螺旋计算机断层扫描进行规划。TAVR 使用双 S 曲线模型进行，该模型是一种在透视下主动脉瓣环和输送导管平面均垂直显示的视图。通过在多排螺旋计算机断层扫描的瓣环平面上重叠左右瓣叶，回顾性生成根据瓣叶重叠技术的最佳投影。在三维空间以及左右前斜位（RAO）和头脚位（CAU）轴上评估两种方法之间的角度差异。
在 92%的患者中，双 S 曲线和瓣叶重叠方法提供的视图位于同一象限，主要是 RAO 和 CAU，三维角度差异中位数为 10.0°（四分位间距：5.5°至 17.9°）。两种方法获得的平均角度之间的三维偏差无统计学意义（1.49°；p = 0.349）。双 S 曲线和瓣叶重叠方法之间的平均坐标无显著差异（RAO：14.7±15.2 与 12.9±12.5；p = 0.36；CAU：27.0±9.4 与 26.9±10.4；p = 0.90）。使用双 S 曲线进行的 TAVR 与 98%的装置成功率、低并发症发生率以及无中重度瓣周漏相关。
双 S 曲线和瓣叶重叠方法提供了相当的 TAVR 投影，主要是 RAO 和 CAU。使用双 S 曲线模型进行的 TAVR 与高装置成功率和低手术并发症发生率相关。
