Background Postprocedural aortic regurgitations following transcatheter aortic valve implantation （TAVI） procedures remain an is- sue. Benefit of oversizing strategies to prevent them isn＇t well established. We com...Background Postprocedural aortic regurgitations following transcatheter aortic valve implantation （TAVI） procedures remain an is- sue. Benefit of oversizing strategies to prevent them isn＇t well established. We compared different level of oversizing in our cohort of con- secutive patients to address if severe oversizing compared to normal sizing had an impact on post-procedural outcomes. Methods From January 2010 to August 2013, consecutive patients were referred for TAVI with preoperative Multislice-CT （MSCT） and the procedures were achieved using Edwards Sapien~ or Corevalve devices~. Retrospectively, according to pre-procedural MSCT and the valve size, pa- tients were classified into three groups： normal, moderate and severe oversizing; depending on the ratio between the prosthesis area and the annulus area indexed and measured on MSCT. Main endpoint was mid-term mortality and secondary endpoints were the Valve Academic Research Consortium （VARC-2） endpoints. Results Two hundred and sixty eight patients had a MSCT and underwent TAVI procedure, with mainly Corevalve~. While all-cause and cardiovascular mortality rates were similar in all groups, post-procedural new pacemaker （PM） implantation rate was significantly higher in the severe oversizing group （P = 0.03）, while we observed more in-hospital congestive heart-failure （P = 0.02） in the normal sizing group. There was a trend toward more moderate to severe aortic regurgitation （AR） in the normal sizing group （P = 0.07）. Conclusions Despite a higher rate of PM implantation, oversizing based on this ratio reduces aortic leak with lower rates of post-procedural complications and a similar mid-term survival.展开更多
The last decade has seen transcatheter aortic valve implantation （TAVI） emerge as the standard of care for patients with severe symptomatic aortic stenosis deemed to be either at excessiveor high-risk for surgical a...The last decade has seen transcatheter aortic valve implantation （TAVI） emerge as the standard of care for patients with severe symptomatic aortic stenosis deemed to be either at excessiveor high-risk for surgical aortic valve replacement （SAVR）. This position is supported by three important multicentre randomized trials comparing TAVI to the historical gold standard therapies： （1） The Placement of AoRTic TraNscathetER Valve Trial Edwards SAPIEN Transcatheter Heart Valve （PARTNER） IB Trial compared TAVI （Edwards SAPIEN, Edwards Lifesciences Inc., Irvine, CA） to optimal medical therapy in patients at excessive surgical risk, and demonstrated an absolute mortality reduction of 〉 20% at 1-year, an effect that was maintained out to 5-year follow-up;Ill （2） The PARTNER 1A Trial compared TAVI （Edwards SAPIEN, Edwards Lifesciences Inc.,展开更多
Background:The study aimed to describe the aortic valve morphology in Chinese patients underwent transcatheter aortic valve replacement(TAVR)for symptomatic severe aortic stenosis(AS),and the impact of sizing strategi...Background:The study aimed to describe the aortic valve morphology in Chinese patients underwent transcatheter aortic valve replacement(TAVR)for symptomatic severe aortic stenosis(AS),and the impact of sizing strategies and related procedural outcomes.Methods:Patients with severe AS who underwent TAVR were consecutively enrolled from 2012 to 2019.The anatomy and morphology of the aortic root were assessed."Downsize"strategy was preformed when patients had complex morphology.The clinical outcomes of patients who performed downsize strategy were compared with those received annular sizing strategy.The primary outcome was device success rate,and secondary outcomes included Valve Academic Research Consortium-3 clinical outcomes variables based on 1-year follow-up.Results:A total of 293 patients were enrolled.Among them,95 patients(32.4%)had bicuspid aortic valve.The calcium volume(Hounsfield Unit-850)of aortic root was 449.90(243.15-782.15)mm3.Calcium is distributed mostly on the leaflet level.Downsize strategy was performed in 204 patients(69.6%).Compared with the patients who performed annular sizing strategy,those received downsize strategy achieved a similar device success rate(82.0%[73]vs.83.3%[170],P=0.79).Aortic valve gradients(downsize strategy group vs.annular sizing group,11.28 mmHg vs.11.88 mmHg,P=0.64)and percentages of patients with moderate or severe paravalvular regurgitation 2.0%(4/204)vs.4.5%(4/89),P=0.21were similar in the two groups at 30 days after TAVR.These echocardiographic results were sustainable for one year.Conclusions:Chinese TAVR patients have more prevalent bicuspid morphology and large calcium volume of aortic root.Calcium is distributed mostly on the leaflet level.Compare with annular sizing strategy,downsize strategy provided a non-inferior device success rate and transcatheter heart valve hemodynamic performance in self-expanding TAVR procedure.展开更多
文摘Background Postprocedural aortic regurgitations following transcatheter aortic valve implantation （TAVI） procedures remain an is- sue. Benefit of oversizing strategies to prevent them isn＇t well established. We compared different level of oversizing in our cohort of con- secutive patients to address if severe oversizing compared to normal sizing had an impact on post-procedural outcomes. Methods From January 2010 to August 2013, consecutive patients were referred for TAVI with preoperative Multislice-CT （MSCT） and the procedures were achieved using Edwards Sapien~ or Corevalve devices~. Retrospectively, according to pre-procedural MSCT and the valve size, pa- tients were classified into three groups： normal, moderate and severe oversizing; depending on the ratio between the prosthesis area and the annulus area indexed and measured on MSCT. Main endpoint was mid-term mortality and secondary endpoints were the Valve Academic Research Consortium （VARC-2） endpoints. Results Two hundred and sixty eight patients had a MSCT and underwent TAVI procedure, with mainly Corevalve~. While all-cause and cardiovascular mortality rates were similar in all groups, post-procedural new pacemaker （PM） implantation rate was significantly higher in the severe oversizing group （P = 0.03）, while we observed more in-hospital congestive heart-failure （P = 0.02） in the normal sizing group. There was a trend toward more moderate to severe aortic regurgitation （AR） in the normal sizing group （P = 0.07）. Conclusions Despite a higher rate of PM implantation, oversizing based on this ratio reduces aortic leak with lower rates of post-procedural complications and a similar mid-term survival.
文摘The last decade has seen transcatheter aortic valve implantation （TAVI） emerge as the standard of care for patients with severe symptomatic aortic stenosis deemed to be either at excessiveor high-risk for surgical aortic valve replacement （SAVR）. This position is supported by three important multicentre randomized trials comparing TAVI to the historical gold standard therapies： （1） The Placement of AoRTic TraNscathetER Valve Trial Edwards SAPIEN Transcatheter Heart Valve （PARTNER） IB Trial compared TAVI （Edwards SAPIEN, Edwards Lifesciences Inc., Irvine, CA） to optimal medical therapy in patients at excessive surgical risk, and demonstrated an absolute mortality reduction of 〉 20% at 1-year, an effect that was maintained out to 5-year follow-up;Ill （2） The PARTNER 1A Trial compared TAVI （Edwards SAPIEN, Edwards Lifesciences Inc.,
基金National Key Research&Development Program of China(No.2020YFC2008100)Project of Capital Clinical Treatment Technology Research and Translation Application(No.Z201100005520068)。
文摘Background:The study aimed to describe the aortic valve morphology in Chinese patients underwent transcatheter aortic valve replacement(TAVR)for symptomatic severe aortic stenosis(AS),and the impact of sizing strategies and related procedural outcomes.Methods:Patients with severe AS who underwent TAVR were consecutively enrolled from 2012 to 2019.The anatomy and morphology of the aortic root were assessed."Downsize"strategy was preformed when patients had complex morphology.The clinical outcomes of patients who performed downsize strategy were compared with those received annular sizing strategy.The primary outcome was device success rate,and secondary outcomes included Valve Academic Research Consortium-3 clinical outcomes variables based on 1-year follow-up.Results:A total of 293 patients were enrolled.Among them,95 patients(32.4%)had bicuspid aortic valve.The calcium volume(Hounsfield Unit-850)of aortic root was 449.90(243.15-782.15)mm3.Calcium is distributed mostly on the leaflet level.Downsize strategy was performed in 204 patients(69.6%).Compared with the patients who performed annular sizing strategy,those received downsize strategy achieved a similar device success rate(82.0%[73]vs.83.3%[170],P=0.79).Aortic valve gradients(downsize strategy group vs.annular sizing group,11.28 mmHg vs.11.88 mmHg,P=0.64)and percentages of patients with moderate or severe paravalvular regurgitation 2.0%(4/204)vs.4.5%(4/89),P=0.21were similar in the two groups at 30 days after TAVR.These echocardiographic results were sustainable for one year.Conclusions:Chinese TAVR patients have more prevalent bicuspid morphology and large calcium volume of aortic root.Calcium is distributed mostly on the leaflet level.Compare with annular sizing strategy,downsize strategy provided a non-inferior device success rate and transcatheter heart valve hemodynamic performance in self-expanding TAVR procedure.
