Breitbart Philipp, Czerny Martin, Minners Jan, Schröfel Holger, Neumann Franz-Josef, Ruile Philipp
Department of Cardiology & Angiology, University Heart Center Freiburg-Bad Krozingen, University Medical Center Freiburg, University of Freiburg, 79189 Bad Krozingen, Germany.
Department of Cardiovascular Surgery, University Heart Center Freiburg-Bad Krozingen, University Medical Center Freiburg, University of Freiburg, 79189 Bad Krozingen, Germany.
J Clin Med. 2022 Apr 18;11(8):2259. doi: 10.3390/jcm11082259.
The impact of transcatheter heart valve (THV) position on the occurrence of paravalvular leakage and permanent pacemaker implantation caused by new-onset conduction disturbances is well described. The purpose of this study was to investigate the influence of the geometry of the thoracic aorta on the implantation depth after TAVI (transcatheter heart valve implantation) using self-expanding valve (SEV) types.
We evaluated three-dimensional geometry of the thoracic aorta based on computed tomography angiography (CTA) in 104 subsequently patients receiving TAVI with SEV devices (Evolut R). Prosthesis position was determined using the fusion imaging method of pre- and post-procedural CTA. An implantation depth of ≥4 mm was defined as the cut-off value for low prosthesis position.
The mean implantation depth of the THV in the whole cohort was 4.3 ± 3.0 mm below annulus plane. THV position was low in 66 (63.5%) patients and high in 38 (36.5%) patients. After multivariate adjustment none of the aortic geometry characteristics showed an independent influence on the prosthesis position-neither the Sinus of Valsalva area ( = 0.335) nor the proximal aortic arch diameter ( = 0.754) or the distance from annulus to descending aorta ( = 0.309).
The geometry of the thoracic aorta showed no influence on the positioning of self-expanding TAVI valve types.
经导管心脏瓣膜（THV）位置对瓣周漏的发生以及新发传导障碍所致永久性起搏器植入的影响已有详尽描述。本研究旨在探讨胸主动脉几何形态对使用自膨胀瓣膜（SEV）类型行经导管主动脉瓣植入术（TAVI）后植入深度的影响。
我们基于计算机断层扫描血管造影（CTA）评估了104例随后接受使用SEV装置（Evolut R）的TAVI患者的胸主动脉三维几何形态。使用术前和术后CTA的融合成像方法确定假体位置。将≥4 mm的植入深度定义为低假体位置的临界值。
整个队列中THV的平均植入深度为瓣环平面以下4.3±3.0 mm。66例（63.5%）患者的THV位置低，38例（36.5%）患者的THV位置高。多变量调整后，没有一项主动脉几何形态特征对假体位置有独立影响——无论是主动脉窦面积（P = 0.335）、近端主动脉弓直径（P = 0.754）还是从瓣环到降主动脉的距离（P = 0.309）。
胸主动脉的几何形态对自膨胀TAVI瓣膜类型的定位没有影响。
