Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China.
West China School of Medicine, Sichuan University, Chengdu, China.
EuroIntervention. 2022 Jun 24;18(3):203-212. doi: 10.4244/EIJ-D-21-00970.
It is unknown whether there are differences in coronary access after transcatheter aortic valve replacement (TAVR) between bicuspid and tricuspid anatomy.
Our aim was to investigate coronary access after TAVR using a self-expanding transcatheter heart valve (THV) in bicuspid versus tricuspid aortic valves (BAV vs TAV), based on CT simulation.
A total of 86 type 0 BAV, 70 type 1 BAV, and 132 TAV patients were included. If the coronary ostium faced the sealed parts of the THV or the tilted-up native leaflet (NL), this was defined as THV- or NL-related challenging coronary access, respectively. If coaxial engagement was not allowed due to interference from the unwrapped frame, THV-related complex coronary access was defined.
The incidence of THV-related challenging coronary access was 21.2% for the left coronary artery (LCA) and 17.7% for the right coronary artery (RCA), and type 0 BAV patients encountered fewer THV-related challenging LCA access than their TAV counterparts (OR 0.42, 95% CI: 0.20-0.89). NL-related challenging coronary access was observed in 3.1% for LCA and 1.4% for RCA, and THV-related complex coronary access was identified in 5.9% for LCA and 17.0% for RCA; however, no significant differences were found among groups. The proportion of optimal fluoroscopic viewing angles suitable for guiding LCA engagement was similar among groups (64.0% vs 70.0% vs 62.1%), but those suitable for guiding RCA engagement were significantly higher in the type 0 BAV group (31.4% vs 4.3% vs 9.1%).
Coronary access may be challenging or complex in a significant proportion of both BAV and TAV patients after TAVR. Type 0 BAV anatomy may be more favourable for post-TAVR coronary access.
经导管主动脉瓣置换术（TAVR）后，二叶式主动脉瓣（BAV）与三叶式主动脉瓣（TAV）的冠状动脉入路是否存在差异尚不清楚。
我们旨在通过 CT 模拟研究使用自膨式经导管心脏瓣膜（THV）在二叶式主动脉瓣（BAV）与三叶式主动脉瓣（TAV）中的 TAVR 后冠状动脉入路。
共纳入 86 例 0 型 BAV、70 例 1 型 BAV 和 132 例 TAV 患者。如果冠状动脉口朝向 THV 的密封部分或倾斜的原生瓣叶（NL），则分别定义为 THV 相关或 NL 相关的挑战性冠状动脉入路。如果由于未包裹的框架干扰而无法同轴接合，则定义为 THV 相关的复杂冠状动脉入路。
左冠状动脉（LCA）THV 相关挑战性入路的发生率为 21.2%，右冠状动脉（RCA）为 17.7%，0 型 BAV 患者的 LCA 与 TAV 患者相比，THV 相关的挑战性 LCA 入路更少（OR 0.42，95%CI：0.20-0.89）。LCA 的 NL 相关挑战性入路发生率为 3.1%，RCA 为 1.4%，LCA 的 THV 相关复杂入路发生率为 5.9%，RCA 为 17.0%；然而，各组之间无显著差异。适合引导 LCA 接合的最佳透视视角比例在各组之间相似（64.0%比 70.0%比 62.1%），但 0 型 BAV 组适合引导 RCA 接合的比例明显更高（31.4%比 4.3%比 9.1%）。
TAVR 后，相当一部分 BAV 和 TAV 患者的冠状动脉入路可能具有挑战性或复杂。0 型 BAV 解剖结构可能更有利于 TAVR 后冠状动脉入路。
