Curio Jonathan, Khokhar Arif A, Beneduce Alessandro, Mylotte Darren, Fezzi Simone, Kim Won-Keun, Zlahoda-Huzior Adriana, Giannini Francesco, Dudek Dariusz
Department of Cardiology, Heart Center Cologne, University of Cologne, Faculty of Medicine and University Hospital, Cologne, Germany.
Cardiology, Imperial College Healthcare NHS Trust, London, UK.
Catheter Cardiovasc Interv. 2023 Dec;102(7):1401-1405. doi: 10.1002/ccd.30828. Epub 2023 Sep 11.
Valve-in-valve TAVI to treat failing surgical aortic valves (SAVs) is increasingly performed, and commissural alignment is a key technical aspect in such procedures. Surgeons optimize valve alignment, accounting for potential coronary eccentricity and achieving a patient-specific optimized commissural orientation, representing the ideal target for TAVI alignment. Therefore, here we present a dedicated stepwise valve-in-valve implantation technique using the ACURATE neo2. In a specific SAV postoverlap view, isolating one surgical post to the right of the screen representing the target for alignment, rotational orientation of the TAVI commissures, matching the SAV orientation, is achieved and verified before implantation. This technique has been tested in a patient-specific three-dimensionally-printed aortic root anatomy, attached to a pulsatile flow simulator, allowing for native-like simulation of coronary cannulations under fluoroscopy, and enabling detailed assessment with fluoroscopic as well as direct videographic visualization. Furthermore, the technique is exemplified by providing an educational clinical case example.
经导管主动脉瓣置入术（TAVI）治疗失败的外科主动脉瓣（SAV）的应用日益广泛，瓣叶对合是此类手术的关键技术环节。外科医生会优化瓣膜对合，考虑潜在的冠状动脉偏心情况，并实现针对特定患者的最佳瓣叶方向，这代表了TAVI对合的理想目标。因此，我们在此介绍一种使用ACURATE neo2瓣膜的专门的分步经导管主动脉瓣置入技术。在特定的SAV重叠后视图中，将屏幕右侧的一个外科瓣叶柱隔离作为对合目标，在植入前实现并验证TAVI瓣叶的旋转方向与SAV方向匹配。该技术已在特定患者的三维打印主动脉根部解剖模型上进行测试，该模型连接到脉动血流模拟器，可在透视下进行类似人体的冠状动脉插管模拟，并通过透视以及直接摄像可视化进行详细评估。此外，通过提供一个具有教育意义的临床病例示例对该技术进行了说明。
