- 作者：Danny Dvir ; MD鈦?/sup> ; Ifat Lavi ; PhD鈦?/sup> ; Hé ; lè ; ne Eltchaninoff ; MD&dagger ; ; Dominique Himbert ; MD&Dagger ; ; Yaron Almagor ; MD§ ; ; Fleur Descoutures ; MD&Dagger ; ; Alec Vahanian ; MD&Dagger ; ; Christophe Tron ; MD&dagger ; ; Alain Cribier ; MD&dagger ; ; Ran Kornowski ; MD鈦?/sup> ; rkornowski@clalit.org.il
- 关键词：aortic stenosis ; transcatheter aortic valve implantation
- 刊名：JACC ; Cardiovascular Interventions
- 出版年：2012
- 期刊代码：pca198_19368798
- 类别：med
- 出版时间：May, 2012
- 卷：5
- 期：5
- 页码：563-570
- 文件大小：1644 K
Objectives
This study sought to evaluate the exact location of Edwards SAPIEN (Edwards Lifesciences, Irvine, California) devices in different stages of implantation and to quantify possible operator-independent device movement during final deployment.Background
Accurate device positioning during transcatheter aortic valve implantation is crucial in order to achieve optimal results.
Methods
This multicenter study consisted of 68 procedures with reliable pacemaker capture. Device positions were assessed using fluoroscopic images and the C-THV system (Paieon Medical, Rosh Ha'Ayin, Israel).
Results
The location after implantation was significantly higher than in the final stage of rapid pacing: 16.7 卤 16.3%of device height below the plane of the lower sinus border versus 32.6 卤 13.8%, p < 0.0001. Operator-independent device-center upper movement during final deployment was 2 卤 1.43 mm, range: 鈭?.3 to 4.6 mm. Device movement was asymmetrical, occurring more in the lower part of the device than in its upper part (3.2 卤 1.4 mm vs. 0.75 卤 1.5 mm, p < 0.001), resulting in device shortening. Multivariate analysis revealed that moderate and severe aortic valve calcification had 49%higher upward movement than mild calcification (p = 0.03), and aortic sinus volume was negatively correlated with movement size (r = 鈭?.35, p = 0.005). This movement was independent of device version (SAPIEN vs. SAPIEN XT), procedural access (transfemoral vs. transapical), and interventricular septum width.
Conclusions
The final Edwards SAPIEN position is mostly aortic in relation to the lower sinus border. There is an operator-independent upward movement of the device center during the final stage of implantation. Anticipated upward movement of the device should influence its positioning before final deployment.