Tirado Conte Gabriela, Arslani Ketina, Zaid Syed, Khokhar Arif, Boiago Mauro, Costa Giulia, Bonnet Guillaume, Mylotte Darren, De Carlo Marco, McInerney Angela, Hovasse Thomas, Campante Teles Rui, Sudre Arnaud, Akodad Mariama, Brito João, Bieliauskas Gintautas, Mahfoud Felix, de Biase Chiara, Piazza Nicolo, Leroux Lionel, Van Mieghem Nicolas M, Tang Gilbert H L, Nombela-Franco Luis, Tchétché Didier, De Backer Ole
Rigshospitalet, Copenhagen, Denmark.
Cardiovascular Institute. Hospital Clínico San Carlos, IdISSC, Madrid, Spain.
Eur Heart J Cardiovasc Imaging. 2025 Jul 2. doi: 10.1093/ehjci/jeaf195.
To evaluate stent frame expansion and ellipticity of the Evolut™ transcatheter heart valve (THV) and its subsequent impact on valve performance in patients with bicuspid aortic stenosis (AS) using pre- and post-procedural cardiac computed tomography (CT). In transcatheter aortic valve implantation (TAVI) for native bicuspid AS, concerns arise regarding the risk for reduced stent frame expansion and increased ellipticity compared with valves implanted in tricuspid AS. The implications of stent frame under-expansion and eccentricity on THV performance remain unclear.
This multicenter registry included patients with bicuspid AS who underwent TAVI using the self-expanding Evolut™ THV and who had pre- and post-TAVI CT. Stent frame expansion and ellipticity were assessed at the inflow (nodes 0-1) and leaflet level (nodes 5-6). THV performance was evaluated by assessing mean transprosthetic gradient, paravalvular leak, and hypoattenuated leaflet thickening. Among 175 patients included, the inflow level of the Evolut THV had greater stent frame under-expansion (79.9% ± 6.7% vs. 95.4% ± 3.1%, p<0.001) and ellipticity (1.3 ± 0.3 vs. 1.2 ± 0.1, p<0.001) compared to the leaflet level. Leaflet level expansion was unaffected by expansion or ellipticity at the inflow level; however, leaflet level ellipticity increased significantly with inflow under-expansion <75% (p=0.002) and inflow ellipticity ≥1.3 (p<0.001). Neither inflow under-expansion nor ellipticity impacted hemodynamic valve performance or leaflet thickening at short-term follow-up.
The self-expanding Evolut™ THV demonstrates consistent valve performance in bicuspid AS. Stent frame under-expansion and ellipticity at the inflow level do not compromise valve hemodynamics or contribute to leaflet thickening at short-term follow-up.
使用术前和术后心脏计算机断层扫描（CT）评估Evolut™经导管心脏瓣膜（THV）的支架框架扩张和椭圆率，及其对二叶式主动脉瓣狭窄（AS）患者瓣膜性能的后续影响。在经导管主动脉瓣植入术（TAVI）治疗原发性二叶式AS中，与植入三叶式AS的瓣膜相比，人们担心支架框架扩张减少和椭圆率增加的风险。支架框架扩张不足和偏心对THV性能的影响仍不清楚。
这项多中心注册研究纳入了接受使用自膨胀Evolut™ THV进行TAVI且有术前和术后CT的二叶式AS患者。在流入端（节点0 - 1）和瓣叶水平（节点5 - 6）评估支架框架扩张和椭圆率。通过评估平均跨瓣压差、瓣周漏和低密度瓣叶增厚来评估THV性能。在纳入的175例患者中，与瓣叶水平相比，Evolut THV的流入端支架框架扩张不足更严重（79.9% ± 6.7% 对 95.4% ± 3.1%，p<0.001），椭圆率更高（1.3 ± 0.3 对 1.2 ± 0.1，p<0.001）。瓣叶水平的扩张不受流入端扩张或椭圆率的影响；然而，当流入端扩张不足<75%（p = 0.002）和流入端椭圆率≥1.3（p<0.001）时，瓣叶水平的椭圆率显著增加。在短期随访中，流入端扩张不足和椭圆率均未影响瓣膜的血流动力学性能或瓣叶增厚。
自膨胀Evolut™ THV在二叶式AS中表现出一致的瓣膜性能。在短期随访中，流入端的支架框架扩张不足和椭圆率不会损害瓣膜血流动力学，也不会导致瓣叶增厚。
