冠状动脉接入的可行性 随着TAVR对Evolut失败的重新处理:计算机断层学模拟研究
Gilbert H L Tang1, Julianne Spencer2, Toby Rogers3
1Department of Cardiovascular Surgery, Mount Sinai Health System, New York (G.H.L.T.).
Circulation. Cardiovascular interventions
|November 21, 2023
概括
预测在重复透气管大动脉置换 (重复TAVR) 后的冠状动脉接入至关重要. 更深的Evolut植入和特定的Sapien-3定位显著改善了冠状动脉可访问性,帮助未来的程序.
科学领域:
- 心血管医学 心血管医学
- 干预心脏病学 干预心脏病学
- 医疗成像医学成像
背景情况:
- 在重复透气管大动脉置换 (重复TAVR) 后冠状动脉接入是一个日益关注的问题,特别是在年轻,风险较低的患者中.
- 确保未来的冠状动脉接入对于经历重复TAVR手术的患者的管理至关重要.
研究的目的:
- 在模拟的Sapien-3门植入预先存在的Evolut门后预测冠状动脉可访问性.
- 通过使用计算机断层扫描 (CT) 成像来评估Evolut植入深度和Sapien-3位置对冠状动脉接入的影响.
主要方法:
- 分析了来自Evolut低风险CT副研究的219个TAVR前CT扫描.
- 虚拟植入Evolut和Sapien-3门,模拟了两个Evolut植入深度 (3毫米和5毫米) 和两个Sapien-3外流位置 (Evolut节点4和节点5).
- 基于模拟的门定位对冠状动脉可访问性的评估.
主要成果:
- 与3毫米深度相比,5毫米深度的Evolut植入物显著改善了冠状动脉可访问性 (97%与84%在节点4;65%与31%在节点5).
- 与节点5相比,Evolut节点4的Sapien-3外流导致了较低的鼻封存,特别是与5毫米的Evolut植入深度相比 (2%对32%).
结论:
- 在重复TAVR后冠状动脉可访问性受到初始Evolut植入深度,Sapien-3外流位置和本地解剖学的影响.
- 基于CT的定量分析可以为初始TAVR提供程序前规划信息,以优化未来的冠状动脉接入和终身管理.
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