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Impact of left ventricular outflow tract calcium on valve geometry in self-expanding transcatheter aortic-valve replacement.
Medranda, Giorgio A; Rogers, Toby; Fuery, Michael; Case, Brian C; Collins, Erin C; Ali, Syed W; Zhang, Cheng; Wang, John C; Weissman, Gaby; Cohen, Jeffrey E; Shults, Christian C; Satler, Lowell F; Ben-Dor, Itsik; Waksman, Ron.
Afiliación
  • Medranda GA; Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia, USA.
  • Rogers T; Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia, USA.
  • Fuery M; Cardiovascular Branch, Division of Intramural Research, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA.
  • Case BC; Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia, USA.
  • Collins EC; Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia, USA.
  • Ali SW; Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia, USA.
  • Zhang C; Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia, USA.
  • Wang JC; Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia, USA.
  • Weissman G; Section of Interventional Cardiology, MedStar Union Memorial Hospital, Baltimore, Maryland, USA.
  • Cohen JE; Department of Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia, USA.
  • Shults CC; Department of Cardiac Surgery, MedStar Washington Hospital Center, Washington, District of Columbia, USA.
  • Satler LF; Department of Cardiac Surgery, MedStar Washington Hospital Center, Washington, District of Columbia, USA.
  • Ben-Dor I; Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia, USA.
  • Waksman R; Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia, USA.
Catheter Cardiovasc Interv ; 100(3): 404-412, 2022 09.
Article en En | MEDLINE | ID: mdl-35723247
OBJECTIVES: Evaluate transcatheter heart valve (THV) geometry according to left ventricular outflow tract (LVOT) calcium degree and its impact on hemodynamics and outcomes in patients undergoing transcatheter aortic valve replacement (TAVR) with a contemporary self-expanding THV. BACKGROUND: LVOT calcium remains challenging for contemporary THVs. LVOT calcium location and degree may affect THV deployment and impact flow patterns and shear stress, accelerating THV degeneration. METHODS: EPROMPT (CoreValve Evolut Pro Prospective Registry; NCT03423459) is a prospective, investigator-initiated, multicenter registry of patients undergoing TAVR using CoreValve Evolut PRO/PRO + THVs. A total of 107 patients were enrolled in EPROMPT's computed tomography (CT) cohort between January 2018 and October 2021. These patients underwent follow-up CT scan 30 days post-TAVR. We analyzed THV geometry and its interaction with the aortic root following deployment using 30-day post-TAVR CT in patients with none/mild versus moderate/severe LVOT calcium. RESULTS: Thirty-day THV inflows were less eccentric in the short axis in patients with none/mild versus moderate/severe LVOT calcium (1.16 ± 0.09 vs. 1.21 ± 0.12; p = 0.007). THV became more circular and was similar between both cohorts at the THV waist (1.08 ± 0.06 vs. 1.09 ± 0.11; p = 0.551), leaflet tips (1.03 ± 0.04 vs. 1.05 ± 0.09; p = 0.299), and THV outflow (1.04 ± 2.2 vs. 1.03 ± 2.7; p = 0.143). Thirty-day > mild paravalvular leak was low in both cohorts (1.5% vs. 2.4%; p = 0.724); mean gradients were similar (7.7 ± 3.6 vs. 7.7 ± 3.4 mmHg; p = 0.955). CONCLUSIONS: Despite inflow deformities observed in patients with moderate/severe LVOT calcium, Evolut PRO/PRO + conforms to elliptical aortic annuli, maintaining circularity and proper function at the leaflets and outflow, even in patients with moderate/severe LVOT calcium.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Estenosis de la Válvula Aórtica / Prótesis Valvulares Cardíacas / Reemplazo de la Válvula Aórtica Transcatéter Tipo de estudio: Clinical_trials / Etiology_studies Límite: Humans Idioma: En Revista: Catheter Cardiovasc Interv Asunto de la revista: CARDIOLOGIA Año: 2022 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Estados Unidos
Texto completo
Añadir a Mi BVS
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Estenosis de la Válvula Aórtica / Prótesis Valvulares Cardíacas / Reemplazo de la Válvula Aórtica Transcatéter Tipo de estudio: Clinical_trials / Etiology_studies Límite: Humans Idioma: En Revista: Catheter Cardiovasc Interv Asunto de la revista: CARDIOLOGIA Año: 2022 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Estados Unidos