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经导管主动脉瓣置换术使用自膨胀式Evolut FX+系统后的冠状动脉插管:CANNULATE TAVR II研究

Coronary Cannulation Following Transcatheter Aortic Valve Replacement With Self-Expanding Evolut FX+ System: The CANNULATE TAVR II Study.

作者信息

Feroze Rafey, Frazzetto Marco, Dasi Lakshmi Prasad, Becker Taylor, Palma Dallan Luis Augusto, Ukaigwe Anene, Filby Steven J, Rushing Gregory, Attizzani Guilherme F

机构信息

Division of Cardiology, Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA.

Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, Georgia, USA.

出版信息

Struct Heart. 2025 Apr 23;9(8):100483. doi: 10.1016/j.shj.2025.100483. eCollection 2025 Aug.

Abstract

•The CANNULATE TAVR II is the first prospective study evaluating coronary cannulation following implantation of the self-expanding Evolut FX+ valve, offering a direct comparison with patients treated using the previous-generation Evolut FX platform.•A novel geometric analysis using preprocedural and postprocedural computed tomography imaging was introduced to assess the spatial relationship between valve apertures and coronary ostia, incorporating the left coronary artery-right coronary artery angle and coronary height differences.•Mean time for the cannulation of the right coronary artery was faster with the newer Evolut FX+ platform compared to the previous generation, despite an experienced operator performing the procedures.•Despite approximately half of the coronaries not being within the apertures of the newer Evolut FX+ platform after post-transcatheter aortic valve replacement computed tomography-scan analysis, a successful coronary cannulation was obtained in 100% of the cases using the same approach as the prior generation, and no modifications were implemented to ensure that the apertures were co-axial with the coronaries.

摘要

•CANNULATE TAVR II是第一项评估自膨胀式Evolut FX+瓣膜植入后冠状动脉插管情况的前瞻性研究,可与使用上一代Evolut FX平台治疗的患者进行直接比较。

•引入了一种新颖的几何分析方法,利用术前和术后计算机断层扫描成像来评估瓣膜孔与冠状动脉口之间的空间关系,包括左冠状动脉-右冠状动脉夹角和冠状动脉高度差异。

•尽管由经验丰富的操作人员进行操作,但与上一代平台相比,使用更新的Evolut FX+平台时右冠状动脉插管的平均时间更快。

•经导管主动脉瓣置换术后计算机断层扫描分析显示,尽管约一半的冠状动脉不在更新的Evolut FX+平台的孔内,但采用与上一代相同的方法,100%的病例成功实现了冠状动脉插管,且未进行任何修改以确保孔与冠状动脉同轴。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/811b/12399255/fbf53a11f288/gr1.jpg

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