外科生物瓣毁损患者使用Venus-A人工瓣膜行经导管主动脉瓣置换术术前CT评估的方法与效果

目的 探讨术前计算机断层扫描(CT)评估外科主动脉生物瓣环内径中多平面曲线瓣环测量法及三维重建法测量间的差异以及基于CT结果指导外科生物瓣毁损患者使用Venus-A瓣膜行经导管主动脉瓣置换术(TAVR)的有效性及安全性.方法 回顾性分析2013年3月至2019年10月连续10例在外科毁损生物瓣中采用Venus-A瓣膜行...

CT Imaging Evaluation for Transcatheter Aortic Valve Replacement with Venus-A valve in Bioprosthetic Valve Deteriorated Patients

Objective To compare the different between the curved multi-planar reconstruction and 3-dimension reconstruction methods to measure the dimensions of the deteriorated surgical bioprosthetic valves and evaluate the role of computed tomography(CT)in transcatheter aortic valve replacement(TAVR)using venus-A valve prosthesis with bioprosthetic valve deteriorated Patients.Methods We retrospectively analyzed 10 consecutive patients with deteriorated surgical bioprosthetic valves who underwent TAVR with the Venus-A valve from March 2013 to October 2019 in Fuwai Hospital.Based on the pre-TAVR CT images,the surgical prosthesis type and size was confirmed.We developed the curved multi-planar reconstruction and 3-dimension reconstruction methods to measure the dimensions of the surgical valve and aortic root.The strategy of TAVR and prothesis size was proposed on the basis of the CT analysis.Results Patients were mainly male(8 cases)and(72.4±5.4)years old with a mean STS score of(7.4±2.1)%.The mean duration of the surgical prosthesis was(8.0±5.4)years.No significant difference was noticed between the diameter by CT and that by multi-planar and 3-dimension reconstruction methods(20.9±1.8]mm vs20.4±2.1]mm,P=0.438).Both of the measurement results by the multi-planar and 3-dimension reconstruction methods were similar with official prosthesis stent inner diameter(20.9±1.8]mm vs21.6±1.9]mm,P=0.217;20.4±2.1]mm vs21.6±1.9]mm,P=0.178).Sinus diameter,STJ diameter and the distance of valve to coronary artery also meet the standard to prevent coronary obstruction.The choice of the TAVR valve size and ballooning strategy were relied on the CT measurement.Only one patient underwent the transcarotid access while others via the femoral artery.Pre-dilatation was observed in two patients.All of the patients implanted Venus-A valve successfully with one case of Residual stenosis after procedure.There was no adverse event except 1 case with cerebral hemorrhage at 30 days.The 30-day echocardiogram outcome were mean aortic peak velocity of 2.6(2.5,2.8)m/s,mean gradients of 13.5(13.0,17.0)mmHg.There was no moderate or severe regurgitation.There was no death or disabled stroke case at 12 months follow-up,and the 12 months echocardiogram outcome were mean aortic peak velocity of 2.7(2.5,3.1)m/s,mean gradients of 15(13.5,21.0)mmHg,no moderate or severe regurgitation.Conclusion Both curved multi-planar reconstruction and 3-dimension reconstruction methods can measure the dimensions of the surgical valves accurately and pre-operative CT evaluation works well in guiding the Venus-A TAVR for patients with deteriorated bioprosthetic valve.