Khalid Abdul Muiz, O'Sullivan Crochan J
College of Medicine and Health, University College Cork, Cork, Ireland.
Front Cardiovasc Med. 2022 Aug 9;9:938653. doi: 10.3389/fcvm.2022.938653. eCollection 2022.
Transcatheter aortic valve replacement (TAVR) is a minimally invasive procedure to replace a diseased and faulty aortic valve in patients with severe aortic stenosis. As TAVR gains popularity among lower-risk younger patients with a longer life expectancy; there is a need to investigate the long-term shortcomings and limitations of the procedure for this patient group. One such shortcoming is that commissural alignment of transcatheter heart valves (THV) appears to be random; meaning that the THV neo-commissures can misalign with the native commissures of the aortic valve during deployment or self-expansion.
Identify techniques and procedures used to obtain commissural alignment in TAVR. Evaluate the effectiveness of these procedures in terms of the degree of commissural alignment. Analyse the impact of commissural alignment on coronary filling and re-access.
Two electronic online databases were searched to identify existing literature relevant to the aim and objectives of this review: EBSCOhost and PubMed. After search filters were applied and duplicates removed; a total of 64 articles from both databases were screened against the inclusion/exclusion criteria. This resulted in a total of thirteen articles which met the objectives of this review and thus; were included.
All studies focused on a patient centered approach involving pre-TAVR computed tomography to obtain commissural alignment. Other studies modified this approach and combined techniques. All studies that implemented a technique to reduce commissural misalignment were significantly successful in obtaining commissural alignment when compared to a study in which alignment was random when no technique was implemented. Severe coronary overlapping in commissural aligned heart valves was relatively low compared to severe coronary overlapping when no technique was implemented.
An increase in optimal commissural alignment introduction of an alignment technique may seem attractive; however; the categorization of commissural alignment is arbitrary and does not accurately reflect real life clinical implications. Further research is needed to determine whether a routine procedure to achieve commissural alignment is necessary in low-risk younger patients undergoing TAVR.
经导管主动脉瓣置换术（TAVR）是一种微创手术，用于替换严重主动脉瓣狭窄患者患病且有缺陷的主动脉瓣。随着TAVR在预期寿命较长的低风险年轻患者中越来越受欢迎，有必要研究该手术对这一患者群体的长期缺点和局限性。其中一个缺点是经导管心脏瓣膜（THV）的瓣叶对齐似乎是随机的，这意味着THV新瓣叶在展开或自膨胀过程中可能与主动脉瓣的天然瓣叶不对齐。
确定在TAVR中用于实现瓣叶对齐的技术和程序。根据瓣叶对齐程度评估这些程序的有效性。分析瓣叶对齐对冠状动脉灌注和再次进入的影响。
检索了两个电子在线数据库，以识别与本综述的目的相关的现有文献：EBSCOhost和PubMed。应用搜索过滤器并去除重复项后，根据纳入/排除标准对两个数据库中的64篇文章进行了筛选。结果共有13篇文章符合本综述的目标，因此被纳入。
所有研究都集中在以患者为中心的方法上，包括术前TAVR计算机断层扫描以实现瓣叶对齐。其他研究对该方法进行了改进并结合了多种技术。与未实施技术时对齐是随机的研究相比，所有实施减少瓣叶不对齐技术的研究在获得瓣叶对齐方面都取得了显著成功。与未实施技术时相比，瓣叶对齐的心脏瓣膜中严重冠状动脉重叠相对较低。
最佳瓣叶对齐的增加——引入对齐技术可能看起来很有吸引力；然而，瓣叶对齐的分类是任意性的，不能准确反映现实生活中的临床意义。对于接受TAVR的低风险年轻患者，是否需要常规程序来实现瓣叶对齐，还需要进一步研究。
