Procedural planning of CS-based indirect mitral annuloplasty using CT-angiography.
circumflex artery
computer tomography
coronary sinus
mitral valve
sizing
Journal
Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions
ISSN: 1522-726X
Titre abrégé: Catheter Cardiovasc Interv
Pays: United States
ID NLM: 100884139
Informations de publication
Date de publication:
01 12 2021
01 12 2021
Historique:
revised:
10
05
2021
received:
30
12
2020
accepted:
05
06
2021
pubmed:
26
6
2021
medline:
6
1
2022
entrez:
25
6
2021
Statut:
ppublish
Résumé
Coronary sinus (CS) based mitral annuloplasty using the Carillon device could be limited by compromise of the left circumflex artery (Cx). Computed tomography (CT) might be a feasible tool for preprocedural planning of indirect mitral valve annuloplasty. In a retrospective analysis, 25 patients underwent Carillon device implantation and received CT-angiography (CTA) analysis prior to CS based percutaneous mitral valve repair. We used a retrospective approach with preprocedural CTA and intraprocedural coronary sinus angiography (CSA) measurements to determine the CS to Cx distance at the occlusion or compression point or in the distal landing zone in absence of Cx compromise. According to left coronary artery angiography, we identified 7 patients with Cx occlusion, 7 with Cx compression and 11 without Cx compromise. No difference in minimal CS to Cx distance between the three groups could be obtained. Also, neither distal CS diameter nor distal Carillon anchor size were related to Cx impingement. However, ROC analysis identified a CS to Cx distance of <8.6 mm specifically in the distal device landing zone to predict Cx compromise. Furthermore, CTA was accurate in assessing device length in comparison to CSA, but failed predicting Carillon device anchor size. CTA derived CS to Cx distance in the device landing zone might be helpful to predict Cx occlusion during Carillon device implantation. Furthermore, CTA predicted CS length but not anchor size correctly. Therefore, CT-angiographic procedural planning might help improving the results of percutaneous CS-based mitral valve repair.
Sections du résumé
OBJECTIVES
Coronary sinus (CS) based mitral annuloplasty using the Carillon device could be limited by compromise of the left circumflex artery (Cx).
BACKGROUND
Computed tomography (CT) might be a feasible tool for preprocedural planning of indirect mitral valve annuloplasty.
METHODS
In a retrospective analysis, 25 patients underwent Carillon device implantation and received CT-angiography (CTA) analysis prior to CS based percutaneous mitral valve repair. We used a retrospective approach with preprocedural CTA and intraprocedural coronary sinus angiography (CSA) measurements to determine the CS to Cx distance at the occlusion or compression point or in the distal landing zone in absence of Cx compromise.
RESULTS
According to left coronary artery angiography, we identified 7 patients with Cx occlusion, 7 with Cx compression and 11 without Cx compromise. No difference in minimal CS to Cx distance between the three groups could be obtained. Also, neither distal CS diameter nor distal Carillon anchor size were related to Cx impingement. However, ROC analysis identified a CS to Cx distance of <8.6 mm specifically in the distal device landing zone to predict Cx compromise. Furthermore, CTA was accurate in assessing device length in comparison to CSA, but failed predicting Carillon device anchor size.
CONCLUSIONS
CTA derived CS to Cx distance in the device landing zone might be helpful to predict Cx occlusion during Carillon device implantation. Furthermore, CTA predicted CS length but not anchor size correctly. Therefore, CT-angiographic procedural planning might help improving the results of percutaneous CS-based mitral valve repair.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1393-1401Commentaires et corrections
Type : CommentIn
Informations de copyright
© 2021 Wiley Periodicals LLC.
Références
Witte KK, Lipiecki J, Siminiak T, et al. The REDUCE FMR trial - a randomized sham-controlled study of percutaneous mitral annuloplasty in functional mitral regurgitation. JACC Heart Fail. 2019;7:945-955.
Lipiecki J, Siminiak T, Sievert H, et al. Coronary sinus-based percutaneous annuloplasty as treatment for functional mitral regurgitation: the TITAN II trial. Open Heart. 2016;3(2):e000411.
Siminiak T, Wu JC, Haude M, et al. Treatment of functional mitral regurgitation by percutaneous annuloplasty: results of the TITAN trial. Eur J Heart Fail. 2012;14:931-938.
Schofer J, Siminiak T, Haude M, et al. Percutaneous mitral annuloplasty for functional mitral regurgitation: results of the CARILLON mitral Annuloplasty device European Union study. Circulation. 2009;120(4):326-333.
Chiam PTL, Ruiz CE. Percutaneous transcatheter mitral valve repair: a classification of the technology. JACC Cardiovasc Interv. 2011;4:1-13.
Tops LF, Van de Veire NR, Schuijf JD, et al. Noninvasive evaluation of coronary sinus anatomy and its relation to the mitral valve annulus. Circulation. 2007;115:1426-1432.
Choure AJ, Garcia MJ, Hesse B, et al. In vivo analysis of the anatomical relationship of coronary sinus to mitral annulus and left circumflex coronary artery using cardiac multidetector computed tomography: implications for percutaneous coronary sinus mitral annuloplasty. J Am Coll Cardiol. 2006;48:1938-1945.
Gheorghe L, Ielasi A, Rensing BJWM, et al. Complications following percutaneous mitral valve repair. Front Cardiovasc Med. 2019;6:146.
Van Mieghem NM, Piazza N, Anderson RH, et al. Anatomy of the mitral valvular complex and its implications for transcatheter interventions for mitral regurgitation. J Am Coll Cardiol. 2010;56:617-626.
Siminiak T, Hoppe UC, Schofer J, et al. Effectiveness and safety of percutaneous coronary sinus-based mitral valve repair in patients with dilated cardiomyopathy (from the AMADEUS trial). Am J Cardiol. 2009;104(4):565-570.
Rottländer D, Ballof J, Gödde M, et al. CT-angiography to predict outcome after indirect mitral annuloplasty in patients with functional mitral regurgitation. Catheter Cardiovasc Interv. 2020;97(3):495-502. https://doi.org/10.1002/ccd.29107
Rottländer D, Schneider T, Degen H, et al. Coronary sinus to mitral valve annulus topography and response to the percutaneous coronary sinus-based mitral valve contour system. EuroIntervention. 2019;15:923-926.
Rottländer D, Degen H, Haude M. The Carillon: strategies for optimal patient selection and optimised results. EuroIntervention. 2016;12:Y64-Y66.
Ponikowski P, Voors AA, Anker SD, et al. 2016 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure: the task force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Eur Heart J. 2016;37(27):2129-2200.
TIMI Study Group. The thrombolysis in myocardial infarction (TIMI) trial. Phase I findings. N Engl J Med. 1985;312(14):932-936. https://doi.org/10.1056/NEJM198504043121437
Lancellotti P, Moura L, Pierard LA, et al. European association of echocardiography recommendations for the assessment of valvular regurgitation. Part 2: mitral and tricuspid regurgitation (native valve disease). Eur J Echocardiogr. 2010;11(4):307-332.
Zoghbi WA, Enriquez-Sarano M, Foster E, et al. Recommendations for evaluation of the severity of native valvular regurgitation with two-dimensional and doppler echocardiography. J Am Soc Echocardiogr. 2003;16(7):777-802.
Abdelghani M, Spitzer E, Soliman OII, et al. A simplified and reproducible method to size the mitral annulus: implications for transcatheter mitral valve replacement. Eur Heart J Cardiovasc Imaging. 2017;18(6):697-706.
Stortecky S, Heg D, Gloekler S, et al. Accuracy and reproducibility of aortic annulus sizing using a dedicated three-dimensional computed tomography reconstruction tool in patients evaluated for Transcatheter aortic valve replacement. EuroIntervention. 2014;10(3):339-346.