Bianchini Francesco, Romagnoli Enrico, Aurigemma Cristina, Lombardi Marco, Graziani Francesca, Iannaccone Giulia, Locorotondo Gabriella, Busco Marco, Malara Silvia, Nesta Marialisa, Bruno Piergiorgio, Girlando Nunzio, Corrado Michele, Natale Luigi, Lombardo Antonella, Burzotta Francesco, Trani Carlo
Department of Cardiovascular and Pulmonary Sciences, Università Cattolica del Sacro Cuore, Rome, Italy.
Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
Cardiovasc Revasc Med. 2025 Jan;70:41-47. doi: 10.1016/j.carrev.2024.06.012. Epub 2024 Jun 13.
The valve-in-valve transcatheter-aortic-valve-implantation (VIV-TAVI) represents an emerging procedure for the treatment of degenerated aortic bio-prostheses, and the occurrence of patient-prosthesis mismatch (PPM) after VIV-TAVI might affect its clinical efficacy. This study aimed to test a multimodal imaging approach to predict PPM risk during the TAVI planning phase and assess its clinical predictivity in VIV-TAVI procedures.
Consecutive patients undergoing VIV-TAVI procedures at our Institution over 6 years were screened and those treated by self-expandable supra-annular valves were selected. The effective orifice area (EOA) was calculated with a hybrid Gorlin equation combining echocardiographic data with invasive hemodynamic assessment. Severe PPM was defined according to such original multimodality assessment as EOAi≤0.65 cm/m (if BMI < 30 kg/m) or < 0.55 cm/m (if BMI ≥ 30 kg/m). The primary endpoint was a composite of all-cause mortality and valve-related re-hospitalization during the clinical follow-up.
A total of 40 VIV-TAVI was included in the analysis. According to the pre-specified multimodal imaging modality assessment, 18 patients (45.0 %) had severe PPM. Among all baseline clinical and anatomical characteristics, estimated glomerular filtration rate before VIV-TAVI (OR 0.872, 95%CI[0.765-0.994],p = 0.040), the echocardiographic pre-procedural ≥moderate AR (OR 0.023, 95%CI[0.001-0.964],p = 0.048), the MSCT-derived effective internal area (OR 0.958, 95%CI[0.919-0.999],p = 0.046) and the implantation depth (OR 2.050, 95%CI[1.028-4.086],p = 0.041) resulted as independent predictors of severe PPM at multivariable logistic analysis. At a mean follow-up of 630 days, patients with severe PPM showed a higher incidence of the primary endpoint (9.1%vs.44.4 %;p = 0.023).
In VIV-TAVI using self-expandable supra-annular valves, a multimodal imaging approach might improve clinical outcome predicting severe PPM occurrence.
瓣中瓣经导管主动脉瓣植入术（VIV-TAVI）是一种用于治疗退化性主动脉生物假体的新兴手术，VIV-TAVI术后发生患者-假体不匹配（PPM）可能会影响其临床疗效。本研究旨在测试一种多模态成像方法，以预测TAVI规划阶段的PPM风险，并评估其在VIV-TAVI手术中的临床预测性。
对我院6年来连续接受VIV-TAVI手术的患者进行筛查，选择使用自膨胀超环瓣治疗的患者。采用混合Gorlin方程结合超声心动图数据和有创血流动力学评估计算有效瓣口面积（EOA）。根据这种原始的多模态评估，将严重PPM定义为EOAi≤0.65 cm/m²（如果BMI<30 kg/m²）或<0.55 cm/m²（如果BMI≥30 kg/m²）。主要终点是临床随访期间全因死亡率和瓣膜相关再住院的复合终点。
共纳入40例VIV-TAVI患者进行分析。根据预先指定的多模态成像方式评估，18例患者（45.0%）有严重PPM。在所有基线临床和解剖特征中，VIV-TAVI术前估计肾小球滤过率（OR 0.872，95%CI[0.765-0.994]，p = 0.040）、术前超声心动图显示≥中度主动脉反流（OR 0.023，95%CI[0.001-0.964]，p = 0.048）、MSCT衍生的有效内部面积（OR 0.958，95%CI[0.919-0.999]，p = 0.046）和植入深度（OR 2.050，95%CI[1.028-4.086]，p = 0.041）在多变量逻辑分析中是严重PPM的独立预测因素。在平均630天的随访中，严重PPM患者的主要终点发生率更高（9.1%对44.4%；p = 0.023）。
在使用自膨胀超环瓣的VIV-TAVI中，多模态成像方法可能会改善预测严重PPM发生的临床结果。
