Wang Rutao, Kawashima Hideyuki, Gao Chao, Mou Fangjun, Li Ping, Zhang Junjie, Yang Jian, Luo Jianfang, Mylotte Darren, Wijns William, Onuma Yoshinobu, Soliman Osama, Tao Ling, Serruys Patrick W
Department of Cardiology, Xijing Hospital, Xi'an, China.
Department of Cardiology, CORRIB Research Center for Advanced Imaging and Core Laboratory, National University of Ireland, NUIG, Galway, Ireland.
Front Cardiovasc Med. 2022 Jan 25;8:747174. doi: 10.3389/fcvm.2021.747174. eCollection 2021.
To compare the quantitative angiographic aortic regurgitation (AR) of six self-expanding valves after transcatheter aortic valve replacement (TAVR).
Quantitative videodensitometric aortography (LVOT-AR) is an accurate and reproducible tool for assessment of AR following TAVR.
This is a retrospective central core-lab analysis of 1,257 consecutive cine aortograms performed post-TAVR. The study included 107 final aortograms of consecutive patients who underwent TAVR with first-generation VitaFlow in four Chinese centers and 1,150 aortograms with five other transcatheter aortic valves (Evolut Pro, Evolut R, CoreValve, Venus A-Valve, and Acurate Neo). LVOT-AR analyses of these five valves were retrieved from a previously published pooled database.
Among 172 aortograms of patients treated with VitaFlow, 107 final aortograms (62.2%) were analyzable by LVOT-AR. In this first in man eight cases necessitated a procedural valve in valve due to inappropriate TAVR positioning and severe aortic paravalvular regurgitation. In the VitaFlow group, the mean LVOT-AR of the intermediate aortograms was 7.3 ± 7.8% and the incidence of LVOT-AR >17% was 8.6%. The mean LVOT-AR of the final aortogram was 6.1 ± 6.4% in the VitaFlow group, followed by Evolut Pro (7.3 ± 6.5%), Evolut R (7.9 ± 7.4%), Venus A-valve (8.9 ± 10.0%), Acurate Neo (9.6 ± 9.2%), and lastly CoreValve (13.7 ± 10.7%) (analysis of variance < 0.001). Post hoc 2-by-2 testing showed that CoreValve had significantly higher LVOT-AR compared with each of the other five THVs. No statistical difference in LVOT-AR was observed between VitaFlow, Evolut Pro, Evolut R, Acurate Neo, and Venus A-valves. The VitaFlow system had the lowest proportion of patients with LVOT-AR >17% (4.7%) (AR after the final aortograms), followed by Evolut Pro (5.3%), Evolut R (8.8%), Acurate Neo (11.3%), Venus A-valve (14.2%), and CoreValve (30.1%) (chi-square < 0.001).
Compared to other commercially available self-expanding valves, VitaFlow seems to have a low degree of AR and a low proportion of patients with ≥moderate/severe AR as assessed by quantitative videodensitometric angiography. Once the learning phase is completed, comparisons of AR between different transcatheter heart valves should be attempted in a prospective randomized trial.
比较经导管主动脉瓣置换术（TAVR）后六种自膨胀瓣膜的定量血管造影主动脉瓣反流（AR）情况。
定量视频密度计主动脉造影术（LVOT-AR）是评估TAVR后AR的一种准确且可重复的工具。
这是一项对TAVR后连续进行的1257例电影主动脉造影进行的回顾性中心核心实验室分析。该研究包括在中国四个中心接受第一代VitaFlow TAVR的连续患者的107份最终主动脉造影，以及另外五种经导管主动脉瓣（Evolut Pro、Evolut R、CoreValve、Venus A-Valve和Acurate Neo）的1150份主动脉造影。这五种瓣膜的LVOT-AR分析数据来自先前发表的汇总数据库。
在接受VitaFlow治疗的患者的172份主动脉造影中，107份最终主动脉造影（62.2%）可通过LVOT-AR进行分析。在这首例人体研究中，8例因TAVR定位不当和严重主动脉瓣周反流而需要进行介入性瓣中瓣手术。在VitaFlow组中，中期主动脉造影的平均LVOT-AR为7.3±7.8%，LVOT-AR>17%的发生率为8.6%。VitaFlow组最终主动脉造影的平均LVOT-AR为6.1±6.4%，其次是Evolut Pro（7.3±6.5%）、Evolut R（7.9±7.4%）、Venus A-valve（8.9±10.0%）、Acurate Neo（9.6±9.2%），最后是CoreValve（13.7±10.7%）（方差分析<0.001）。事后两两检验显示，CoreValve的LVOT-AR显著高于其他五种经导管心脏瓣膜中的任何一种。在VitaFlow、Evolut Pro、Evolut R、Acurate Neo和Venus A-valve之间，LVOT-AR未观察到统计学差异。VitaFlow系统中LVOT-AR>17%的患者比例最低（4.7%）（最终主动脉造影后的AR），其次是Evolut Pro（5.3%）、Evolut R（8.8%）、Acurate Neo（11.3%）、Venus A-valve（14.2%）和CoreValve（30.1%）（卡方检验<0.001）。
与其他市售自膨胀瓣膜相比，通过定量视频密度计血管造影评估，VitaFlow似乎具有较低程度的AR以及≥中度/重度AR患者的低比例。一旦学习阶段完成，应尝试在前瞻性随机试验中比较不同经导管心脏瓣膜之间的AR情况。
