Department of Cardiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, Canada.
EuroIntervention. 2024 Nov 18;20(22):1390-1404. doi: 10.4244/EIJ-D-24-00619.
Redo-transcatheter aortic valve implantation (TAVI) is the treatment of choice for failed transcatheter aortic valves. Currently, implantation of a SAPIEN 3 (S3) is indicated for redo-TAVI in degenerated CoreValve/Evolut (CV/EV) transcatheter aortic valves (TAVs) but is not well understood.
We aimed to evaluate S3 function following implantation in explanted calcified CV/EV TAVs and to assess the impact of CV/EV pathology on redo-TAVI outcomes.
Ex vivo hydrodynamic testing was performed per the International Organization for Standardization (ISO) 5840-3 standard on 4 S3 TAVs implanted at node 5 in calcified CV/EV explants. The mean gradient (MG), effective orifice area (EOA), peak velocity, regurgitant fraction (RF), geometric orifice area (GOA), leaflet overhang, leaflet pinwheeling, neoskirt height, and frame deformation were evaluated.
CV/EV explants were calcified and stenotic. Following S3 implantation, the MG and peak velocity decreased. As per the ISO standard, all S3 implants showed adequate EOA, and 3 out of 4 had an RF within the accepted value (<20%). CV/EV leaflet overhang ranged from 25-37%. Calcified leaflets remained stationary throughout the cardiac cycle (difference <9%) and were not pinned in a manner that constrained S3 systolic flow or appeared to prevent selective frame cannulation. The downstream CV/EV GOA was larger than the upstream S3 GOA during systole. S3 frame underexpansion was seen, resulting in leaflet pinwheeling (range 13-30%). Above the neoskirt, calcium protrusion was observed in contact with the S3 leaflets.
S3 implantation at node 5 in calcified CV/EV valves resulted in satisfactory hydrodynamic performance in most configurations tested with stable leaflet overhang throughout the cardiac cycle. The long-term implications of S3 underexpansion, leaflet pinwheeling, and calcium protrusion require future studies.
经导管主动脉瓣置换术（TAVI）失败后的再次介入治疗是首选治疗方法。目前，SAPIEN 3（S3）瓣膜植入物适用于退行性 CoreValve/Evolut（CV/EV）经导管主动脉瓣（TAV）置换术后的再次 TAVI，但对其了解甚少。
我们旨在评估在钙化的 CV/EV 经导管主动脉瓣置换术后 S3 瓣膜的功能，并评估 CV/EV 病理对再次 TAVI 结果的影响。
按照国际标准化组织（ISO）5840-3 标准，对 4 个植入钙化 CV/EV 瓣叶标本中的节点 5 的 S3 经导管主动脉瓣进行体外血流动力学测试。评估平均梯度（MG）、有效开口面积（EOA）、峰值速度、反流分数（RF）、几何开口面积（GOA）、瓣叶突出、瓣叶涡旋、新裙边高度和框架变形。
CV/EV 瓣叶钙化和狭窄。S3 植入后，MG 和峰值速度下降。根据 ISO 标准，所有 S3 植入物均显示出足够的 EOA，4 个中有 3 个 RF 值在可接受范围内（<20%）。CV/EV 瓣叶突出范围为 25-37%。钙化瓣叶在整个心动周期内保持静止（差异<9%），没有被固定在限制 S3 收缩期血流的方式，也没有出现瓣叶似乎阻止选择性框架插管的情况。收缩期时 CV/EV 下游 GOA 大于 S3 上游 GOA。S3 框架扩张不足，导致瓣叶涡旋（范围 13-30%）。在新裙边上方，观察到钙突与 S3 瓣叶接触。
在钙化的 CV/EV 瓣叶中，节点 5 处的 S3 瓣膜植入物在大多数测试配置中均表现出满意的血流动力学性能，瓣叶突出在整个心动周期内保持稳定。S3 扩张不足、瓣叶涡旋和钙突的长期影响需要进一步研究。
