Dataset Information

Commissural and coronary alignment of the Venus-A valve after transcatheter aortic valve replacement: a retrospective cross-sectional study.

ABSTRACT:

Background

Previous studies have shown that neo-commissural orientation of transcatheter heart valve (THV) can influence coronary obstruction during transcatheter aortic valve replacement (TAVR), long-term durability of THV, and coronary artery access for reintervention after TAVR. Specific initial orientations of Evolut R/Pro and Acurate Neo aortic valves can improve commissural alignment. However, the method of achieving commissural alignment with the Venus-A valve remains unknown. Therefore, this study aimed to evaluate the extent of commissural and coronary alignment of the Venus-A self-expanding valve after TAVR using a standard system delivery technique.

Methods

A retrospective cross-sectional study was performed. At the time of enrollment, patients who underwent pre- and post-procedural electrocardiographically-gated contrast-enhanced CT with a second-generation 64-row multidetector scanner were selected for the study. Commissural alignment was categorized as aligned (0-15° angle deviation), mild (15-30°), moderate (30-45°), or severe (45-60°) commissural misalignment (CMA). Coronary alignment was categorized as having no coronary overlap (CO) (>35°), moderate CO (20-35°), or severe CO (≤20°). The results were represented as proportions to assess the extent of commissural and coronary alignment.

Results

Forty-five TAVR patients were ultimately included in the analysis. THVs were shown to be randomly implanted: 20.0% of THVs were aligned, 33.3% had mild CMA, 26.7% had moderate CMA, and 20.0% had severe CMA. The incidence of severe CO was 24.4% with the left main coronary artery, 28.9% with the right coronary artery, 6.7% with both coronary arteries, and 46.7% with one or both coronary arteries.

Conclusions

The results showed that commissural or coronary alignment could not be achieved with the Venus-A valve using a standard system delivery technique. Therefore, specific methods to attain alignment with the Venus-A valve need to be identified.

SUBMITTER: Xi S

PROVIDER: S-EPMC10315423 | biostudies-literature | 2023 Jun

REPOSITORIES: biostudies-literature

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Publications

Commissural and coronary alignment of the Venus-A valve after transcatheter aortic valve replacement: a retrospective cross-sectional study.

Xi Siyu S Zhang Haishan H Gao Yuan Y Chen Xin X Tan Wenfei W Guo Liang L Sun Yingxian Y

Cardiovascular diagnosis and therapy 20230510 3

<h4>Background</h4>Previous studies have shown that neo-commissural orientation of transcatheter heart valve (THV) can influence coronary obstruction during transcatheter aortic valve replacement (TAVR), long-term durability of THV, and coronary artery access for reintervention after TAVR. Specific initial orientations of Evolut R/Pro and Acurate Neo aortic valves can improve commissural alignment. However, the method of achieving commissural alignment with the Venus-A valve remains unknown. The ...[more]

PMID: 37405016

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Project description:IntroductionTranscatheter aortic valve replacement (TAVR) is a minimally invasive procedure to replace a diseased and faulty aortic valve in patients with severe aortic stenosis. As TAVR gains popularity among lower-risk younger patients with a longer life expectancy; there is a need to investigate the long-term shortcomings and limitations of the procedure for this patient group. One such shortcoming is that commissural alignment of transcatheter heart valves (THV) appears to be random; meaning that the THV neo-commissures can misalign with the native commissures of the aortic valve during deployment or self-expansion.ObjectivesIdentify techniques and procedures used to obtain commissural alignment in TAVR. Evaluate the effectiveness of these procedures in terms of the degree of commissural alignment. Analyse the impact of commissural alignment on coronary filling and re-access.MethodsTwo electronic online databases were searched to identify existing literature relevant to the aim and objectives of this review: EBSCOhost and PubMed. After search filters were applied and duplicates removed; a total of 64 articles from both databases were screened against the inclusion/exclusion criteria. This resulted in a total of thirteen articles which met the objectives of this review and thus; were included.ResultsAll studies focused on a patient centered approach involving pre-TAVR computed tomography to obtain commissural alignment. Other studies modified this approach and combined techniques. All studies that implemented a technique to reduce commissural misalignment were significantly successful in obtaining commissural alignment when compared to a study in which alignment was random when no technique was implemented. Severe coronary overlapping in commissural aligned heart valves was relatively low compared to severe coronary overlapping when no technique was implemented.ConclusionsAn increase in optimal commissural alignment via introduction of an alignment technique may seem attractive; however; the categorization of commissural alignment is arbitrary and does not accurately reflect real life clinical implications. Further research is needed to determine whether a routine procedure to achieve commissural alignment is necessary in low-risk younger patients undergoing TAVR.

Project description:Background Transcatheter aortic valve replacement (TAVR) in the treatment of patients with pure native aortic valve regurgitation (NAVR) has been based on the “off-label” indications, while the absence of aortic valve calcification and difficulty in anchoring was found to significantly increase the risk of prosthesis malposition. The aim of this study was to explore the anatomical predictors of severe prosthesis malposition following TAVR with the self-expandable Venus-A Valve among patients with NAVR. Methods A total of 62 patients with NAVR who underwent TAVR with Venus-A Valve at four Chinese clinical centers were retrospectively observed. The clinical features, aortic multidetector computed tomography (MDCT) data, and clinical outcomes were compared between non-/mild malposition and severe malposition groups. Univariate logistic regression analysis was used to identify the risk factors of severe prosthesis malposition, and the receiver operating characteristic (ROC) curve was used to explore the predictive value of the risk factors. Results Valve migration to ascending aortic direction occurred in 1 patient, and the remaining 61 patients (including 19 severe malposition cases and 42 non-/mild malposition cases) were included in the analysis. The diameter and height of the sinotubular junction (STJ) and STJ cover index (STJCI, calculated as 100%*STJ diameter/nominal prosthesis crown diameter) were all greater in the severe malposition group (all p < 0.05). Logistic regression showed that STJ diameter (OR = 1.23, 95% CI 1.04–1.47, p = 0.017), STJ height (OR = 1.24, 95% CI 1.04–1.47, p = 0.017), and STJCI (OR = 1.08, 95% CI 1.01–1.16, p = 0.032) were potential predictors for severe prosthesis malposition. The area under the ROC curve was 0.72 (95% CI 0.58–0.85, p = 0.008) for STJ diameter, 0.70 (95% CI 0.55–0.86, p = 0.012) for STJ height, and 0.69 (95% CI 0.55–0.83, p = 0.017) for STJCI, respectively. The cutoff value was 33.2 mm for STJ diameter (sensitivity was 84.2% and specificity was 65.8%), 24.1 mm for STJ height (sensitivity was 57.9% and specificity was 87.8%), and 81.0% for STJCI (sensitivity was 68.4% and specificity was 68.3%), respectively. Conclusion Larger and higher STJ, as well as greater STJ to valve crown diameter ratio, may help identify patients at high risk for severe prosthesis malposition among patients with NAVR undergoing TAVR with Venus-A prosthesis valve.

Dataset Information

Commissural and coronary alignment of the Venus-A valve after transcatheter aortic valve replacement: a retrospective cross-sectional study.

Background

Methods

Results

Conclusions

Publications

Commissural and coronary alignment of the Venus-A valve after transcatheter aortic valve replacement: a retrospective cross-sectional study.

Similar Datasets

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