27280 Department of Cardiac Surgery, Medical University of Innsbruck, Austria.
Department of Anesthesiology and Critical Care Medicine, Medical University of Innsbruck, Austria.
Innovations (Phila). 2021 May-Jun;16(3):254-261. doi: 10.1177/1556984521995200. Epub 2021 Mar 18.
Patients undergoing transcatheter aortic valve implantation (TAVI) frequently present with chronic kidney disease and are therefore particularly susceptible to nephrotoxic influences like iodinated contrast media. Acute kidney injury after TAVI is a severe complication that independently predicts short- and long-term mortality. The present study investigates the feasibility of a contrast-free approach by using intravascular ultrasound (IVUS) in conjunction with fluoroscopy.
Six domestic pigs (60 ± 5 kg) were anesthetized and underwent transapical implantation of a balloon-expandable transcatheter heart valve. In the control group ( = 3), the procedures were guided by fluoroscopy/angiography. In the study group ( = 3), the procedures were guided by IVUS for preimplantation evaluation, intra-procedural guidance, and post-implantation evaluation, in conjunction with fluoroscopy without contrast. The procedures were evaluated by IVUS, fluoroscopy, aortic root angiography, and explantation and dissection of the hearts.
Relevant anatomical landmarks for correct implantation were assessed by IVUS. The following annulus measurements were obtained: area (359.67 ± 29.58 mm), perimeter (68.28 ± 2.63 mm), maximum diameter (22.20 ± 1.22 mm), minimum diameter (20.43 ± 1.12 mm), mean diameter (21.32 ± 0.70 mm), ellipticity index (1.09 ± 0.10), and area-derived diameter (21.39 ± 0.87 mm). IVUS-guided valve deployment resulted in correct expansion within the aortic annulus without signs of paravalvular leak, compromised mitral valve, or coronary obstruction. IVUS-guided post-implantation assessment confirmed circular expansion (25.88 ± 0.30 mm) of the valves.
IVUS-guided, contrast-free transapical TAVI is feasible in a porcine model.
接受经导管主动脉瓣植入术（TAVI）的患者常患有慢性肾脏病，因此特别容易受到碘造影剂等肾毒性影响。TAVI 后急性肾损伤是一种严重的并发症，独立预测短期和长期死亡率。本研究通过血管内超声（IVUS）与透视相结合，探讨了无对比剂方法的可行性。
六只国产猪（60±5kg）麻醉后经心尖植入球囊扩张型经导管心脏瓣膜。在对照组（n=3）中，手术过程由透视/血管造影引导。在研究组（n=3）中，手术过程由 IVUS 进行术前评估、术中引导和术后评估，与无对比剂的透视相结合。通过 IVUS、透视、主动脉根部血管造影以及心脏的解剖和离体评估来评估手术过程。
IVUS 评估了正确植入所需的相关解剖学标志。获得了以下瓣环测量值：面积（359.67±29.58mm）、周长（68.28±2.63mm）、最大直径（22.20±1.22mm）、最小直径（20.43±1.12mm）、平均直径（21.32±0.70mm）、椭圆率指数（1.09±0.10）和面积直径（21.39±0.87mm）。IVUS 引导的瓣膜展开导致在主动脉瓣环内正确扩张，无瓣周漏、二尖瓣受损或冠状动脉阻塞的迹象。IVUS 引导的术后评估证实了瓣膜的圆形扩张（25.88±0.30mm）。
在猪模型中，IVUS 引导的无对比剂经心尖 TAVI 是可行的。
