Spaccarotella Carmen A M, Sorrentino Sabato, Mongiardo Annalisa, Riverso Vincenzo, Mancuso Cinzia, Giordano Salvatore, Esposito Giovanni, Indolfi Ciro
Division of Cardiology, Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples.
Division of Cardiology, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy.
J Cardiovasc Med (Hagerstown). 2023 May 1;24(5):308-312. doi: 10.2459/JCM.0000000000001459. Epub 2023 Mar 20.
The acute adaptation of the nitinol-based stent frame self expandable valve to the aortic root after deployment is poorly understood. Accordingly, this study aimed to assess the occurrence, degree and determinants of acute adaptation of the nitinol-based stent frame self-expandable valves after implantation.
This is a single-site prospective registry including patients undergoing transcatheter aortic valve replacement (TAVR) with a widely used second-generation nitinol-based self-expandable device (Evolut R, Medtronic, Minneapolis, Minnesota, USA). We measured valve diameters at three different sections: distal (aortic) level, central (annulus) level and proximal (ventricular) level. Valve expansion was estimated by the difference between the diameters calculated immediately after valve deployment (A) and at the end of the procedure (B). The absolute and relative stent changes were defined as B-A and (B-A)/B∗100, respectively. A linear regression model was performed to test the association between the degree of valve extension at each segment with baseline and procedural characteristics.
A total of 58 consecutive TAVR patients were included in this analysis, with a mean age of 82.12 ± 5.28 years. Out of the total, 46% of the patients had chronic kidney disease, 32% had diabetes and 76% had dyslipidaemia. The mean procedural time was 28.11 ± 11.6 min, with 53.45% of predilation. Postdilation was performed only in 3.5% of patients. Final stent diameters were significantly higher than those achieved immediately after valve implantation - an observation that was consistent for all the segments: 0.50 ± 0.51 mm and 2.48 ± 2.57% ( P < 0.01) in the proximal, 0.46 ± 0.57 mm and 2.39 ± 2.96% ( P < 0.01) in the central, as well as 0.58 ± 0.59 mm and 2.14 ± 2.14% ( P < 0.01) at the distal segments. Postdilation significantly affected the expansion of the central segment, and, albeit not significantly, the proximal one, while no changes were observed for the distal portion of the platform.
This is the first study to have documented a significant degree of the Evolut R self-expandable valve expansion after deployment. However, further studies are required to assess the short- and long-term time course of self-expandable valve enlargement and the clinical relevance of this finding.
镍钛诺基自膨胀瓣膜支架在植入后对主动脉根部的急性适应性仍知之甚少。因此，本研究旨在评估镍钛诺基自膨胀瓣膜支架植入后急性适应性的发生率、程度及相关因素。
这是一项单中心前瞻性注册研究，纳入了接受经导管主动脉瓣置换术（TAVR）且使用广泛的第二代镍钛诺基自膨胀装置（美国美敦力公司的Evolut R，明尼阿波利斯，明尼苏达州）的患者。我们在三个不同部位测量瓣膜直径：远端（主动脉）水平、中央（瓣环）水平和近端（心室）水平。瓣膜扩张程度通过瓣膜植入后即刻（A）和手术结束时（B）计算的直径之差来估计。绝对和相对支架变化分别定义为B - A和（B - A）/B×100。采用线性回归模型检验各节段瓣膜扩张程度与基线及手术特征之间的关联。
本分析共纳入58例连续的TAVR患者，平均年龄82.12±5.28岁。其中，46%的患者患有慢性肾脏病，32%患有糖尿病，76%患有血脂异常。平均手术时间为28.11±11.6分钟，预扩张率为53.45%。仅3.5%的患者进行了后扩张。最终支架直径显著高于瓣膜植入后即刻的直径——所有节段均观察到这一现象：近端为0.50±0.51毫米和2.48±2.57%（P<0.01），中央为0.46±0.57毫米和2.39±2.96%（P<0.01），远端为0.58±0.59毫米和2.14±2.14%（P<0.01）。后扩张显著影响中央节段的扩张，对近端节段虽无显著影响，但平台远端部分未观察到变化。
这是第一项记录Evolut R自膨胀瓣膜植入后有显著扩张程度的研究。然而，需要进一步研究来评估自膨胀瓣膜扩张的短期和长期时间进程以及这一发现的临床相关性。
