Kalińczuk Łukasz, Mintz Gary S, Skotarczak Wiktor, Sadowski Karol A, Stokołosa Patrycjusz, Kochańska Sara, Dzielińska Zofia, Woźniak Olgierd, Kubik Agata, Kowalik Ilona, Sondergaard Lars, Witkowski Adam, Michałowska Ilona, Demkow Marcin
National Institute of Cardiology, Warsaw, Poland.
Cardiovascular Research Foundation, New York, New York, USA.
Struct Heart. 2024 Apr 17;8(5):100300. doi: 10.1016/j.shj.2024.100300. eCollection 2024 Sep.
Actual expansion of a transcatheter heart valve (THV) might differ from nominal, particularly during nonaortic valve-in-valve for a degenerated bioprosthetic surgical heart valve (SHV). This pilot study compared THV expansion measured using large-field-of-view intravascular ultrasound (IVUS) vs. multi-slice computed tomography (MSCT) and assessed the correlation between THV dimensions and transvalvular gradients.
Fourteen patients were successfully treated with mitral/tricuspid valve-in-valve SAPIEN 3 implantation sized using the true SHV inner diameter; all 14 had baseline MSCT and transvalvular gradients measured at baseline, postprocedure, and at discharge. Periprocedural IVUS (in 6 patients using a Philips 10MHz Vision PV035) was compared with postprocedural MSCT (in 9 patients) with offline measurements performed at 1-mm steps along the THV height. Overall, 190 MSCT and paired 124 IVUS cross-sections were analyzed.
There was very good agreement between IVUS THV dimensions and corresponding MSCT measurements (intraclass correlation coefficient ≥0.986 and < 0.001). IVUS measured THV expansion (percent of the nominal cross-sectional area) was smaller within the inflow and middle of the THV overlapping the ring (85.9% ± 11.3%, 83.8% ± 11.8%) than within the outflow (98.8% ± 12.7%). The residual mean transvalvular gradient increased from periprocedural to predischarge (3.5 ± 2.0 vs. 6.3 ± 1.7 mmHg, < 0.001). The only independent predictor of predischarge maximal transvalvular gradient was the smallest minimal inner THV frame diameter (r = 0.67), predicted by true SHV internal diameter (Beta = 0.066, 95% CI = 0.015-0.117, r = 0.49, = 0.037).
This pilot study is the first to report the feasibility of a large field-of-view IVUS for periprocedural measurement of actual THV expansion when deployed valve-in-valve. Minimal inner THV stent frame dimensions correlate with increased postprocedural transvalvular gradients.
经导管心脏瓣膜（THV）的实际扩张情况可能与标称值不同，尤其是在用于退化生物人工心脏瓣膜（SHV）的非主动脉瓣中瓣手术时。这项前瞻性研究比较了使用大视野血管内超声（IVUS）与多层螺旋计算机断层扫描（MSCT）测量的THV扩张情况，并评估了THV尺寸与跨瓣压差之间的相关性。
14例患者成功接受了二尖瓣/三尖瓣瓣中瓣SAPIEN 3植入术，使用真实SHV内径进行尺寸选择；所有14例患者均在基线、术后和出院时进行了MSCT检查和跨瓣压差测量。将围手术期IVUS（6例患者使用飞利浦10MHz Vision PV035）与术后MSCT（9例患者）进行比较，沿THV高度以1mm步长进行离线测量。总共分析了190个MSCT横截面和124对配对的IVUS横截面。
IVUS测量的THV尺寸与相应的MSCT测量结果之间具有很好的一致性（组内相关系数≥0.986，<0.001）。IVUS测量的THV扩张（标称横截面积的百分比）在THV流入和与瓣环重叠的中部较小（85.9%±11.3%，83.8%±11.8%），而在流出道较大（98.8%±12.7%）。残余平均跨瓣压差从围手术期到出院前增加（3.5±2.0 vs. 6.3±1.7 mmHg，<0.001）。出院前最大跨瓣压差的唯一独立预测因素是最小的THV内框架直径（r = 0.67），由真实SHV内径预测（β = 0.066，95% CI = 0.015 - 0.117，r = 0.49，= 0.037）。
这项前瞻性研究首次报告了大视野IVUS在瓣中瓣手术中围手术期测量实际THV扩张的可行性。最小的THV支架内框架尺寸与术后跨瓣压差增加相关。
