In vitro coronary flow after transcatheter aortic valve-in-valve implantation: A comparison of 2 valves

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• 作者：Sina Stock ; MD^a ; Michael Scharfschwerdt ; PhD^a ; Roza Meyer-Saraei ; PhD^a ; Doreen Richardt ; MD^a ; Efstratios I. Charitos ; MD ; PhD^b ; Hans-Hinrich Sievers ; MD^a ; ^{Hans-Hinrich.Sievers@uksh.de} ; Thorsten Hanke ; MD^a
• 关键词：dPmax ; maximum pressure gradient ; dPmean ; mean pressure gradient ; GOA ; geometric orifice area ; LCF ; left coronary flow ; RCF ; right coronary flow ; SAVB ; surgical aortic valve bioprosthesis ; TAVI-ViV ; transcatheter aortic valve-in-valve implantation ; THV ; transcatheter heart valve
• 刊名：The Journal of Thoracic and Cardiovascular Surgery
• 出版年：2017
• 出版时间：February 2017
• 年：2017
• 卷：153
• 期：2
• 页码：255-263.e1
• 全文大小：1533 K
• 卷排序：153

文摘

Transcatheter aortic valve-in-valve implantation (TAVI-ViV) is an evolving treatment strategy for degenerated surgical aortic valve bioprostheses (SAVBs). However, there is some concern regarding coronary obstruction, especially after TAVI-ViV in calcified SAVBs with externally mounted leaflets. We investigated in vitro coronary flow and hydrodynamics after TAVI-ViV using 2 modern SAVBs with externally and internally mounted leaflets.MethodsAortic root models including known risk factors for coronary obstruction served for the implantation of SAVBs with either externally mounted leaflets (St Jude Trifecta, size 25) or internally mounted leaflets (Edwards Perimount Magna Ease, size 25). Left and right coronary flow, as well as hydrodynamic parameters, were measured before and after TAVI-ViV with an Edwards Sapien XT transcatheter heart valve, size 23. After the first experimental run, the SAVB leaflets were artificially “calcified,” and the measurements were repeated.ResultsIn both models, noncalcified and calcified, there was no significant reduction in coronary flow with either the Trifecta or the Perimount Magna Ease SAVB. After TAVI-ViV, in the noncalcified model, the mean pressure gradient was increased (Trifecta, P = .0001; Perimount Magna Ease, P = .006) and the geometric orifice area was decreased (P < .001 for both), whereas in the calcified model, the mean pressure gradient was decreased (P < .001 for both) and the geometric orifice area was increased (P < .001 for both).ConclusionsIn our specific model, in noncalcified as well as calcified conditions, TAVI-ViV is feasible with either SAVB (Trifecta or Perimount Magna Ease) without an increased risk of coronary obstruction. Nevertheless, before clinical application of these results, thorough preoperative assessment, considering the different limitations of this model, is mandatory.