Raschpichler Matthias, Flint Nir, Yoon Sung-Han, Kaewkes Danon, Patel Chinar, Singh Chetana, Patel Vivek, Kashif Mohammad, Borger Michael A, Chakravarty Tarun, Makkar Raj
Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA; Leipzig Heart Center, University Clinic of Cardiac Surgery, Leipzig, Germany.
Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA; Tel Aviv Sourasky Medical Center affiliated to the Sackler faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
JACC Cardiovasc Interv. 2022 Jun 13;15(11):1126-1136. doi: 10.1016/j.jcin.2022.04.006.
Transcatheter aortic valve replacement (TAVR) is generally performed without control over the alignment of the bioprosthesis to the native aortic valve (AV) commissures. Data on the impact of commissural misalignment (CMA) on the clinical and hemodynamic outcome after TAVR are scarce.
The aim of this study was to investigate the impact of commissural misalignment (CMA) on the clinical and hemodynamic outcome in patients with severe tricuspid aortic stenosis undergoing TAVR using the balloon-expandable (BE) SAPIEN 3 valve (Edwards LifeSciences).
Clinical data of consecutive patients who underwent BE TAVR at Cedars-Sinai Medical Center (Los Angeles, California, USA) enrolled in the RESOLVE (Assessment of TRanscathetER and Surgical Aortic BiOprosthetic Valve Thrombosis and Its TrEatment With Anticoagulation) registry were retrospectively analyzed to evaluate CMA, which was defined as a neocommissure position >30° compared with native commissures on computed tomography.
A total of 324 patients (36.6% female, median Society of Thoracic Surgeons score of 3.9%) were included in the analysis. CMA was present in 171 individuals (52.8%). At 30 days, rates of aortic regurgitation greater than mild (5.6%) and a residual AV gradient ≥20 mm Hg (7.4%) were not different between CMA and non-CMA patients. Commissural orientation was independently associated with a relative AV mean gradient increase >50% from discharge to 30 days (per increase of 10° misalignment; OR: 1.3; 95% CI: 1.0-1.4; P = 0.01). The long-term composite outcome of death or stroke was not different between groups (log-rank P = 0.29).
In patients with severe tricuspid aortic stenosis who undergo SAPIEN 3 TAVR, the neocommissures align randomly. Our data demonstrate that commissural alignment may impact device performance and clinical outcomes in patients undergoing BE TAVR. (Assessment of TRanscathetEr and Surgical Aortic BiOprosthetic VaLVve Dysfunction with Multimodality Imaging and Its TrEatment with Anticoagulation [RESOLVE]; NCT02318342).
经导管主动脉瓣置换术（TAVR）通常在无法控制生物瓣膜与天然主动脉瓣（AV）瓣叶交界对齐的情况下进行。关于瓣叶交界未对齐（CMA）对TAVR术后临床和血流动力学结果影响的数据很少。
本研究旨在探讨使用球囊扩张式（BE）SAPIEN 3瓣膜（爱德华生命科学公司）对重度三尖瓣主动脉瓣狭窄患者进行TAVR时，瓣叶交界未对齐（CMA）对临床和血流动力学结果的影响。
回顾性分析美国加利福尼亚州洛杉矶雪松西奈医疗中心连续接受BE TAVR并纳入RESOLVE（经导管和外科主动脉生物瓣膜血栓形成及其抗凝治疗评估）注册研究的患者的临床数据，以评估CMA，其定义为计算机断层扫描上与天然瓣叶交界相比新瓣叶交界位置>30°。
共有324例患者（女性占36.6%，胸外科医师协会评分中位数为3.9%）纳入分析。171例个体（52.8%）存在CMA。在30天时，CMA组和非CMA组中，中重度主动脉瓣反流发生率（5.6%）和残余AV压差≥20 mmHg的发生率（7.
