Chen Yang, Lu Zhi-Nan, Yao Jing, Wang Mo-Yang, Niu Guan-Nan, Zhang Hong-Liang, Liu Qing-Rong, Zhao Jie, Zhao Zhen-Yan, Perrin Nils, Modine Thomas, Wu Yong-Jian, Song Guang-Yuan
Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China.
Interventional Center of Valvular Heart Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
Echocardiography. 2022 Dec;39(12):1571-1580. doi: 10.1111/echo.15490. Epub 2022 Nov 14.
The success of transcatheter aortic valve replacement (TAVR) in native aortic regurgitation (AR) is limited by the absence of calcified anchoring structures. We sought to evaluate transfemoral TAVR in patients with native AR using a novel aortic root imaging classification.
From March to November 2021, 81 patients with severe AR were prospectively enrolled in 2 cardiac centers in China. All were evaluated using multidetector computed tomography (MDCT) and classified into 4 anatomic types in reference to transcatheter heart valve (THV) anchoring: Type 1: anchoring at the left ventricular outflow tract (LVOT), annulus, and ascending aorta (AA); Type 2: anchoring at the annulus and AA; Type 3: anchoring at the annulus and LVOT; and Type 4: anchoring at only 1 level or none at all. Based on the dual-anchoring strategy, patients with Types 1-3 were considered TAVR candidates. Procedural and 30-day outcomes were assessed according to Valve Academic Research Consortium-3 definitions.
TAVR was performed in 32 (39.5%) patients (71.9 ± 8.0 years of age, 71.9% were male) using 2 self-expanding THVs. Types 1, 2, and 3 comprised 13 (40.6%), 11 (34.4%), and 8 (25.0%) cases, respectively. The procedural and device success rates were 100% and 93.8%, respectively, with 2 THV migration. Eight patients (25.0%) required a permanent pacemaker, and 2 (6.3%) developed moderate paravalvular leaks. No deaths or other major complications occurred during the study.
The novel anatomic classification and dual-anchoring strategy were associated with a high procedural success rate with favorable short-term safety and clinical outcomes.
经导管主动脉瓣置换术（TAVR）在原发性主动脉瓣反流（AR）中的成功率受到缺乏钙化锚定结构的限制。我们试图使用一种新型主动脉根部成像分类方法评估原发性AR患者的经股动脉TAVR。
2021年3月至11月，81例重度AR患者在中国的2个心脏中心进行前瞻性入组。所有患者均使用多排螺旋计算机断层扫描（MDCT）进行评估，并根据经导管心脏瓣膜（THV）锚定情况分为4种解剖类型：1型：锚定在左心室流出道（LVOT）、瓣环和升主动脉（AA）；2型：锚定在瓣环和AA；3型：锚定在瓣环和LVOT；4型：仅锚定在1个层面或完全无锚定。基于双锚定策略，1-3型患者被视为TAVR候选者。根据瓣膜学术研究联盟-3的定义评估手术和30天结局。
32例（39.5%）患者（年龄71.9±8.0岁，71.9%为男性）接受了TAVR，使用了2种自膨胀THV。1、2和3型分别包括13例（40.6%）、11例（34.4%）和8例（25.0%）。手术成功率和器械成功率分别为100%和93.8%，有2例THV移位。8例患者（25.0%）需要植入永久性起搏器，2例（6.3%）出现中度瓣周漏。研究期间无死亡或其他重大并发症发生。
新型解剖分类和双锚定策略与高手术成功率相关，短期安全性和临床结局良好。
