Department of Cardiovascular Surgery, German Heart Centre Munich, Technical University Munich, Munich, Germany.
Department of Cardiovascular Surgery, Insure (Institute of Translational Cardiac Surgery), German Heart Centre Munich, Technical University Munich, Munich, Germany.
J Card Surg. 2021 Dec;36(12):4537-4545. doi: 10.1111/jocs.16025. Epub 2021 Sep 27.
The dual-filter Sentinel™ Cerebral Protection System (Sentinel-CPS) is increasingly used during transcatheter aortic valve replacement (TAVR). However, complex vascular anatomy may challenge Sentinel-CPS deployment.
We sought to investigate the impact of anatomic features of the aortic arch and the supra-aortic arteries on technical device failure of Sentinel-CPS application.
Analysis of the multislice computed tomography pre-TAVR aortograms of all patients undergoing TAVR with Sentinel-CPS between 2016 and 2020 (n = 92) was performed. We investigated the impact of aortic arch anatomy, configuration, and the angles of the supra-aortic arteries, including the determination of vascular tortuosity index on device failure of Sentinel-CPS application.
The Sentinel-CPS was applied successfully in 83 patients (90.2%). Device failure in nine patients (9.8%) was due to the infeasibility to perform correct deployment of both filters (n = 7) and to obtain peripheral radial access (n = 2). Patients with a failure of Sentinel-CPS application had a higher right subclavian tortuosity index (217 [92-324] vs. 150 [42-252], p = .046), a higher brachiocephalic tortuosity index (27 [5-51] vs. 10 [0-102], p = 0.033) and a larger angulation of the brachiocephalic artery (59° [22-80] vs. 39° [7-104], p = .014) compared with patients with successful application. A brachiocephalic angle more than 59° was predictive for device failure. No differences in aortic arch anatomy or common carotid artery tortuosity were detected between the groups.
Brachiocephalic tortuosity was found to be associated with failure of Sentinel-CPS application. Filter-based usage should be avoided in TAVR patients with a brachiocephalic angle more than 59°.
在经导管主动脉瓣置换术（TAVR）中，越来越多地使用双滤网 Sentinel™ 脑保护系统（Sentinel-CPS）。然而，复杂的血管解剖结构可能会对 Sentinel-CPS 的部署造成挑战。
我们旨在研究主动脉弓和主动脉上动脉的解剖特征对 Sentinel-CPS 应用技术设备故障的影响。
对 2016 年至 2020 年间接受 TAVR 并使用 Sentinel-CPS 的所有患者（n=92）的多排螺旋 CT 术前主动脉造影进行分析。我们研究了主动脉弓解剖结构、形态以及主动脉上动脉的角度，包括血管迂曲指数对 Sentinel-CPS 应用设备故障的影响。
83 例患者（90.2%）成功应用 Sentinel-CPS。9 例患者（9.8%）设备应用失败，原因是无法正确放置两个滤网（n=7）和获得外周径向入路（n=2）。Sentinel-CPS 应用失败的患者右锁骨下动脉迂曲指数较高（217[92-324]比 150[42-252]，p=0.046），头臂动脉迂曲指数较高（27[5-51]比 10[0-102]，p=0.033），头臂动脉夹角较大（59°[22-80]比 39°[7-104]，p=0.014）。与成功应用患者相比，头臂动脉夹角大于 59°的患者更易发生设备故障。两组间主动脉弓解剖结构或颈总动脉迂曲程度无差异。
头臂动脉迂曲与 Sentinel-CPS 应用失败相关。头臂动脉夹角大于 59°的 TAVR 患者应避免使用滤网。
