Yasuda Masakazu, Mizutani Kazuki, Onishi Kyohei, Onishi Naoko, Fujita Kosuke, Ueno Masafumi, Okamura Atsushi, Iwanaga Yoshitaka, Sakaguchi Genichi, Nakazawa Gaku
Division of Cardiology, Sakurabashi Watanabe Advanced Healthcare Hospital, OSAKA, Japan.
Division of Cardiology, Department of Internal Medicine, Kindai University Faculty of Medicine, OSAKA, Japan.
Cardiovasc Interv Ther. 2025 Jan;40(1):133-143. doi: 10.1007/s12928-024-01040-2. Epub 2024 Sep 6.
The hemodynamic impact of the implantation depth for balloon-expandable valves is under-investigated, especially with higher implantation techniques. We assessed the hemodynamic performance of supra-annular SAPIEN 3 valve implantation. This retrospective study involved consecutive patients who underwent transcatheter aortic valve replacement (TAVR) using the SAPIEN 3. The device implantation depth and transcatheter heart valve (THV) leaflet-nadir position were angiographically analyzed, and supra-annular implantation was defined as a higher leaflet-nadir position than the original annular line. The Doppler hemodynamic status was evaluated at patient discharge. Among 184 patients, 120 (65%) underwent supra-annular implantation, and their mean implantation depth was significantly lower than that of intra-annular implantation (1.1 vs. 5.2 mm, p < 0.001). No patients developed valve embolization or coronary occlusion, and none required the TAV-in-TAV procedure. Two (1.6%) patients in the supra-annular implantation group had a mild or greater paravalvular leak. Echocardiography demonstrated that supra-annular implantation had better hemodynamic performance, showing a larger indexed effective orifice area (iEOA) compared with intra-annular implantation (1.09 vs. 0.97 cm/m, p < 0.01). There was a weak but negative correlation between the implantation depth and iEOA (r = - 0.27, p < 0.01). Moderate or severe prosthesis-patient mismatch (PPM) was found in 35.9% of the intra-annular group and 9.2% of supra-annular of the supra-annular group (p < 0.01). In the multivariable analysis, supra-annular implantation was an independent predictor of better THV function (iEOA > 0.85). Supra-annular SAPIEN 3 implantation provides beneficial hemodynamic effects and reduces the PPM risk.
球囊扩张瓣膜植入深度的血流动力学影响研究不足，尤其是在采用更高植入技术的情况下。我们评估了瓣环上SAPIEN 3瓣膜植入的血流动力学性能。这项回顾性研究纳入了连续接受使用SAPIEN 3进行经导管主动脉瓣置换术（TAVR）的患者。通过血管造影分析装置植入深度和经导管心脏瓣膜（THV）瓣叶最低点位置，瓣环上植入定义为瓣叶最低点位置高于原始瓣环线。在患者出院时评估多普勒血流动力学状态。184例患者中，120例（65%）接受了瓣环上植入，其平均植入深度显著低于瓣环内植入（1.1 vs. 5.2 mm，p<0.001）。无患者发生瓣膜栓塞或冠状动脉闭塞，也无人需要进行瓣中瓣手术。瓣环上植入组有2例（1.6%）患者出现轻度或更严重的瓣周漏。超声心动图显示，瓣环上植入具有更好的血流动力学性能，与瓣环内植入相比，其指数化有效瓣口面积（iEOA）更大（1.09 vs. 0.97 cm/m，p<0.01）。植入深度与iEOA之间存在微弱的负相关（r = -0.27，p<0.01）。瓣环内植入组35.9%的患者和瓣环上植入组9.2%的患者存在中度或重度人工瓣膜-患者不匹配（PPM）（p<0.01）。在多变量分析中，瓣环上植入是THV功能更好（iEOA>0.85）的独立预测因素。瓣环上SAPIEN 3植入可提供有益的血流动力学效应并降低PPM风险。
