Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA.
Department of Cardiology, MedStar Washington Hospital Center, Washington, DC, USA.
EuroIntervention. 2022 Aug 5;18(5):e407-e416. doi: 10.4244/EIJ-D-21-01091.
Given enough time, transcatheter heart valves (THVs) will degenerate and may require reintervention. Redo transcatheter aortic valve implantation (TAVI) is an attractive strategy but carries a risk of coronary obstruction.
We sought to predict how many TAVIs patients could undergo in their lifetime using computed tomography (CT) simulation.
We analysed paired CT scans (baseline and 30 days post-TAVI) from patients in the LRT trial and EPROMPT registry. We implanted virtual THVs on baseline CTs, comparing predicted valve-to-coronary (VTC) distances to 30-day CT VTC distances to evaluate the accuracy of CT simulation. We then simulated implantation of a second virtual THV within the first to estimate the risk of coronary obstruction due to sinus sequestration and the need for leaflet modification.
We included 213 patients with evaluable paired CTs. There was good agreement between virtual (baseline) and actual (30 days) CT measurements. CT simulation of TAVI followed by redo TAVI predicted low coronary obstruction risk in 25.4% of patients and high risk, likely necessitating leaflet modification, in 27.7%, regardless of THV type. The remaining 46.9% could undergo redo TAVI so long as the first THV was balloon-expandable but would likely require leaflet modification if the first THV was self-expanding.
Using cardiac CT simulation, it is possible to predict whether a patient can undergo multiple TAVI procedures in their lifetime. Those who cannot may prefer to undergo surgery first. CT simulation could provide a personalised lifetime management strategy for younger patients with symptomatic severe aortic stenosis and inform decision-making.
gov: NCT02628899; ClinicalTrials.gov: NCT03557242; ClinicalTrials.gov: NCT03423459.
经导管心脏瓣膜（THV）会随着时间的推移而退化，可能需要再次介入。再次行经导管主动脉瓣植入术（TAVI）是一种有吸引力的策略，但存在冠状动脉阻塞的风险。
我们试图通过计算机断层扫描（CT）模拟预测患者一生中可以进行多少次 TAVI。
我们分析了 LRT 试验和 EPROMPT 注册中心的患者配对 CT 扫描（基线和 TAVI 后 30 天）。我们在基线 CT 上植入虚拟 THV，将预测的瓣膜-冠状动脉（VTC）距离与 30 天 CT VTC 距离进行比较，以评估 CT 模拟的准确性。然后，我们模拟植入第二个虚拟 THV，以估计窦隔离和需要瓣叶修改导致冠状动脉阻塞的风险。
我们纳入了 213 例可评估配对 CT 的患者。虚拟（基线）和实际（30 天）CT 测量之间存在良好的一致性。TAVI 后 CT 模拟随后进行 redo TAVI 预测 25.4%的患者冠状动脉阻塞风险低，27.7%的患者风险高，可能需要瓣叶修改，而不管 THV 类型如何。其余 46.9%的患者可以进行 redo TAVI，但前提是第一个 THV 是球囊扩张的，但如果第一个 THV 是自扩张的，可能需要瓣叶修改。
使用心脏 CT 模拟，可以预测患者一生中是否可以进行多次 TAVI 手术。那些不能进行 TAVI 手术的患者可能更愿意先进行手术。CT 模拟可以为有症状的严重主动脉瓣狭窄的年轻患者提供个性化的终生管理策略，并为决策提供信息。
gov：NCT02628899；ClinicalTrials.gov：NCT03557242；ClinicalTrials.gov：NCT03423459。
