在自我扩张的ACURATE neo2门中进行重复TAVI的可行性:计算机断层扫描研究
Gintautas Bieliauskas1, Yusuke Kobari1, Arif A Khokhar1,2
1The Heart Center, Rigshospitalet, Copenhagen, Denmark.
概括
在ACURATE neo2 (ACn2) 门内使用SAPIEN 3 (S3) 门进行再通气管大动脉植入 (TAVI) 是可行的. 低S3植入物位置将冠状动脉流量损害的风险降至最低,并改善冠状动脉接入.
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:
- 重新通透导管大动脉植入 (TAVI) 由于初始的潜在冠状动脉阻塞带来了挑战.
- 确保冠状动脉流和通道对于成功的重复TAVI手术至关重要.
研究的目的:
- 在重复TAVI过程中,评估在自扩展ACURATE neo2 (ACn2) 门中植入SAPIEN 3 (S3) 门的可行性.
- 在这个重复TAVI情景中,确定冠状动脉流量妥协的预测因素.
主要方法:
- 在ACn2 TAVI后对153个心脏CT扫描进行分析.
- 模拟S3植入低位 (流向上方冠状) 和高位 (流向 commissural 位) 的位置.
- 基于新皮高度和门到大动脉的距离来评估冠状动脉流量损害风险.
主要成果:
- 低S3植入物位置预测冠状动脉流量损害8%的患者,而高位置的60%.
- 在52% (低) 和13% (高) 的患者中,冠状动脉接入预计不受限制.
- 女性性别,小的大动脉环,和阴管结与大动脉环比<1.15预测冠状动脉损伤的高风险.
结论:
- 在ACn2中使用S3的Redo-TAVI可行性取决于S3植入深度和大动脉几何.
- 较低的S3植入物位置与降低冠状动脉流量损害的风险和改善接入有关.
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