Anatomical morphology of the aortic valve in Chinese aortic stenosis patients and clinical results after downsize strategy of transcatheter aortic valve replacement.
Journal
Chinese medical journal
ISSN: 2542-5641
Titre abrégé: Chin Med J (Engl)
Pays: China
ID NLM: 7513795
Informations de publication
Date de publication:
20 Dec 2022
20 Dec 2022
Historique:
pubmed:
3
2
2023
medline:
25
2
2023
entrez:
2
2
2023
Statut:
epublish
Résumé
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. 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. 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) mm 3 . 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 = 0.21) were similar in the two groups at 30 days after TAVR. These echocardiographic results were sustainable for one year. 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.
Sections du résumé
BACKGROUND
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
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
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) mm 3 . 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 = 0.21) were similar in the two groups at 30 days after TAVR. These echocardiographic results were sustainable for one year.
CONCLUSIONS
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.
Identifiants
pubmed: 36728213
doi: 10.1097/CM9.0000000000002517
pii: 00029330-202212200-00009
pmc: PMC10106152
doi:
Substances chimiques
Calcium
SY7Q814VUP
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
2968-2975Informations de copyright
Copyright © 2023 The Chinese Medical Association, produced by Wolters Kluwer, Inc. under the CC-BY-NC-ND license.
Références
Adams DH, Popma JJ, Reardon MJ, Yakubov SJ, Coselli JS, Deeb GM, et al. Transcatheter aortic-valve replacement with a self-expanding prosthesis. N Engl J Med 2014; 370:1790–1798. doi: 10.1056/NEJMoa1400590.
doi: 10.1056/NEJMoa1400590
Leon MB, Smith CR, Mack M, Miller DC, Moses JW, Svensson LG, et al. Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery. N Engl J Med 2010; 363:1597–1607. doi: 10.1056/NEJMoa1008232.
doi: 10.1056/NEJMoa1008232
Smith CR, Leon MB, Mack MJ, Miller DC, Moses JW, Svensson LG, et al. Transcatheter versus surgical aortic-valve replacement in high-risk patients. N Engl J Med 2011; 364:2187–2198. doi: 10.1056/NEJMoa1103510.
doi: 10.1056/NEJMoa1103510
Reardon MJ, Van Mieghem NM, Popma JJ, Kleiman NS, Sondergaard L, Mumtaz M, et al. Surgical or transcatheter aortic-valve replacement in intermediate-risk patients. N Engl J Med 2017; 376:1321–1331. doi: 10.1056/NEJMoa1700456.
doi: 10.1056/NEJMoa1700456
Thourani VH, Kodali S, Makkar RR, Herrmann HC, Williams M, Babaliaros V, et al. Transcatheter aortic valve replacement versus surgical valve replacement in intermediate-risk patients: a propensity score analysis. Lancet 2016; 387:2218–2225. doi: 10.1016/s0140-6736(16)30073-3.
doi: 10.1016/s0140-6736(16)30073-3
Leon MB, Smith CR, Mack MJ, Makkar RR, Svensson LG, Kodali SK, et al. Transcatheter or surgical aortic-valve replacement in intermediate-risk patients. N Engl J Med 2016; 374:1609–1620. doi: 10.1056/NEJMoa1514616.
doi: 10.1056/NEJMoa1514616
Mack MJ, Leon MB, Thourani VH, Makkar R, Kodali SK, Russo M, et al. Transcatheter aortic-valve replacement with a balloon-expandable valve in low-risk patients. N Engl J Med 2019; 380:1695–1705. doi: 10.1056/NEJMoa1814052.
doi: 10.1056/NEJMoa1814052
Popma JJ, Deeb GM, Yakubov SJ, Mumtaz M, Gada H, O’Hair D, et al. Transcatheter aortic-valve replacement with a self-expanding valve in low-risk patients. N Engl J Med 2019; 380:1706–1715. doi: 10.1056/NEJMoa1816885.
doi: 10.1056/NEJMoa1816885
Zahn R, Werner N, Gerckens U, Linke A, Sievert H, Kahlert P, et al. Five-year follow-up after transcatheter aortic valve implantation for symptomatic aortic stenosis. Heart 2017;103:1970–1976. doi: 10.1136/heartjnl-2016-311004.
doi: 10.1136/heartjnl-2016-311004
Kochman J, Huczek Z, Scislo P, Dabrowski M, Chmielak Z, Szymanski P, et al. Comparison of one- and 12-month outcomes of transcatheter aortic valve replacement in patients with severely stenotic bicuspid versus tricuspid aortic valves (results from a multicenter registry). Am J Cardiol 2014; 114:757–762. doi: 10.1016/j.amjcard.2014.05.063.
doi: 10.1016/j.amjcard.2014.05.063
Halim SA, Edwards FH, Dai D, Li Z, Mack MJ, Holmes DR, et al. Outcomes of transcatheter aortic valve replacement in patients with bicuspid aortic valve disease: a report from the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry. Circulation 2020; 141:1071–1079. doi: 10.1161/CIRCULATIONAHA.119.040333.
doi: 10.1161/CIRCULATIONAHA.119.040333
Song G, Jilaihawi H, Wang M, Chen M, Wang J, Wang W, et al. Severe symptomatic bicuspid and tricuspid aortic stenosis in China: characteristics and outcomes of transcatheter aortic valve replacement with the venus-A valve. Struct Heart 2018; 2:60–68. doi: 10.1080/24748706.2017.1398437.
doi: 10.1080/24748706.2017.1398437
Zhao ZG, Feng Y, Liao YB, Li YJ, Xiong TY, Ou YW, et al. Reshaping bicuspid aortic valve stenosis with an hourglass-shaped balloon for transcatheter aortic valve replacement: a pilot study. Catheter Cardiovasc Interv 2020; 95: (Suppl 1): 616–623. doi: 10.1002/ccd.28726.
doi: 10.1002/ccd.28726
Liu X, He Y, Zhu Q, Gao F, He W, Yu L, et al. Supra-annular structure assessment for self-expanding transcatheter heart valve size selection in patients with bicuspid aortic valve. Catheter Cardiovasc Interv 2018; 91:986–994. doi: 10.1002/ccd.27467.
doi: 10.1002/ccd.27467
Sievers HH, Schmidtke C. A classification system for the bicuspid aortic valve from 304 surgical specimens. J Thorac Cardiovasc Surg 2007; 133:1226–1233. doi: 10.1016/j.jtcvs.2007.01.039.
doi: 10.1016/j.jtcvs.2007.01.039
Blanke P, Weir-McCall JR, Achenbach S, Delgado V, Hausleiter J, Jilaihawi H, et al. Computed tomography imaging in the context of transcatheter aortic valve implantation (TAVI)/transcatheter aortic valve replacement (TAVR): an expert consensus document of the society of cardiovascular computed tomography. JACC Cardiovasc Imaging 2019; 12:1–24. doi: 10.1016/j.jcmg.2018.12.003.
doi: 10.1016/j.jcmg.2018.12.003
VARC-3 WRITING COMMITTEE, Généreux P, Piazza N, Alu MC, Nazif T, Hahn RT, et al. Valve academic research consortium 3: updated endpoint definitions for aortic valve clinical research. Eur Heart J 2021; 42:1825–1857. doi: 10.1093/eurheartj/ehaa799.
doi: 10.1093/eurheartj/ehaa799
Jilaihawi H, Makkar RR, Kashif M, Okuyama K, Chakravarty T, Shiota T, et al. A revised methodology for aortic-valvar complex calcium quantification for transcatheter aortic valve implantation. Eur Heart J Cardiovasc Imaging 2014; 15:1324–1332. doi: 10.1093/ehjci/jeu162.
doi: 10.1093/ehjci/jeu162
Bettinger N, Khalique OK, Krepp JM, Hamid NB, Bae DJ, Pulerwitz TC, et al. Practical determination of aortic valve calcium volume score on contrast-enhanced computed tomography prior to transcatheter aortic valve replacement and impact on paravalvular regurgitation: Elucidating optimal threshold cutoffs. J Cardiovasc Comput Tomogr 2017; 11:302–308. doi: 10.1016/j.jcct.2017.04.009.
doi: 10.1016/j.jcct.2017.04.009
Kim WK, Renker M, Rolf A, Liebetrau C, Van Linden A, Arsalan M, et al. Accuracy of device landing zone calcium volume measurement with contrast-enhanced multidetector computed tomography. Int J Cardiol 2018; 263:171–176. doi: 10.1016/j.ijcard.2018.02.042.
doi: 10.1016/j.ijcard.2018.02.042
Iung B, Delgado V, Rosenhek R, Price S, Prendergast B, Wendler O, et al. Contemporary presentation and management of valvular heart disease: The EURObservational Research Programme Valvular Heart Disease II Survey. Circulation 2019; 140:1156–1169. doi: 10.1161/circulationaha.119.041080.
doi: 10.1161/circulationaha.119.041080
Zhang B, Xu H, Zhang H, Liu Q, Ye Y, Hao J, et al. Prognostic value of N-terminal pro-B-type natriuretic peptide in elderly patients with valvular heart disease. J Am Coll Cardiol 2020; 75:1659–1672. doi: 10.1016/j.jacc.2020.02.031.
doi: 10.1016/j.jacc.2020.02.031
Yoon SH, Kim WK, Dhoble A, Milhorini Pio S, Babaliaros V, Jilaihawi H, et al. Bicuspid aortic valve morphology and outcomes after transcatheter aortic valve replacement. J Am Coll Cardiol 2020; 76:1018–1030. doi: 10.1016/j.jacc.2020.07.005.
doi: 10.1016/j.jacc.2020.07.005
Forrest JK, Ramlawi B, Deeb GM, Zahr F, Song HK, Kleiman NS, et al. Transcatheter aortic valve replacement in low-risk patients with bicuspid aortic valve stenosis. JAMA Cardiol 2021; 6:50–57. doi: 10.1001/jamacardio.2020.4738.
doi: 10.1001/jamacardio.2020.4738
Blackman DJ, Van Gils L, Bleiziffer S, Gerckens U, Petronio AS, Abdel-Wahab M, et al. Clinical outcomes of the Lotus Valve in patients with bicuspid aortic valve stenosis: an analysis from the RESPOND study. Catheter Cardiovasc Interv 2019; 93:1116–1123. doi: 10.1002/ccd.28120.
doi: 10.1002/ccd.28120
De Biase C, Mastrokostopoulos A, Philippart R, Desroche LM, Blanco S, Rehal K, et al. Aortic valve anatomy and outcomes after transcatheter aortic valve implantation in bicuspid aortic valves. Int J Cardiol 2018; 266:56–60. doi: 10.1016/j.ijcard.2018.01.018.
doi: 10.1016/j.ijcard.2018.01.018
John D, Buellesfeld L, Yuecel S, Mueller R, Latsios G, Beucher H, et al. Correlation of device landing zone calcification and acute procedural success in patients undergoing transcatheter aortic valve implantations with the self-expanding CoreValve prosthesis. JACC Cardiovasc Interv 2010; 3:233–243. doi: 10.1016/j.jcin.2009.11.015.
doi: 10.1016/j.jcin.2009.11.015
Xiong TY, Li YJ, Feng Y, Liao YB, Zhao ZG, Mylotte D, et al. Understanding the interaction between transcatheter aortic valve prostheses and supra-annular structures from post-implant stent geometry. JACC Cardiovasc Interv 2019; 12:1164–1171. doi: 10.1016/j.jcin.2019.02.051.
doi: 10.1016/j.jcin.2019.02.051
Tchetche D, de Biase C, van Gils L, Parma R, Ochala A, Lefevre T, et al. Bicuspid aortic valve anatomy and relationship with devices: the BAVARD Multicenter Registry. Circ Cardiovasc Interv 2019; 12:e007107doi: 10.1161/circinterventions.118.007107.
doi: 10.1161/circinterventions.118.007107