Can Measuring the ‘Dual Anchors of Aorta’ Enhance the Success Rate of TAVR?—A Single-Center Experience
Abstract
:1. Introduction
2. Background
3. Materials and Methods
3.1. Study Population
3.2. MDCT Evaluation and Anatomical Classification
3.3. Operation
3.4. Perioperative Outcome and Follow-Up
3.5. Statistical Analysis
4. Results
4.1. Basic Characteristics of Patients with Chronic Severe AR Undergoing TAVR Treatment
4.2. Preoperative MDCT Anatomical Characteristics
4.3. Operation Outcome and Device Failure Analysis
4.4. Follow-Up Outcomes
5. Discussion
6. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Standards | Contents |
---|---|
Inclusion criteria | |
Age ≥ 55 years | |
Symptomatic severe AR | |
American Association of Chest Physicians score > 4% | |
New York Heart Association grades II–IV | |
MDCT evaluation anatomy appropriate for TAVR treatment | |
Exclusion criteria | |
Acute myocardial infarction within 30 days | |
Left ventricular ejection fraction ≤ 20% | |
Life expectancy < 1 year | |
Mild to moderate AR | |
With moderate to severe aortic stenosis | |
Previous aortic valve replacement | |
Inappropriate MDCT evaluation anatomy | |
Other THV treatments |
Characteristics (n, %) | Total N = 37 | Type 1 N = 17 | Type 2 N = 3 | Type 3 N = 13 | Type 4 N = 4 | p |
---|---|---|---|---|---|---|
Age | 73.1 ± 8.7 | 71.4 ± 7.2 | 67.7 ± 11.0 | 73.7 ± 9.9 | 82.3 ± 4.3 abc | 0.096 |
Male | 23 (62.2) | 10 (58.8) | 3 (100.0) | 7 (53.8) | 3 (75.0) | 0.463 |
STS score (%) | 8.6 ± 2.1 | 7.9 ± 1.9 | 7.7 ± 0.8 | 9.2 ± 2.2 | 10.2 ± 2.5 | 0.123 |
Coronary artery disease | 14 (37.8) | 6 (35.3) | 3 (100.0) | 4 (30.8) | 1 (25.0) | 0.137 |
Previous PCI | 3 (8.1) | 2 (11.8) | 1 (33.3) | 0 | 0 | 0.224 |
Previous CABG | 2 (5.4) | 1 (5.9) | 1 (33.3) | 0 | 0 | 0.135 |
Atrial fibrillation | 13 (35.1) | 6 (35.5) | 1 (33.3) | 4 (30.8) | 2 (50.0) | 0.919 |
Previous PPI | 2 (5.4) | 1 (5.9) | 0 | 1 (7.7) | 0 | 0.910 |
hypertension | 23 (62.2) | 9 (52.9) | 2 (66.7) | 11 (84.6) | 1 (25.0) | 0.123 |
Hyperlipidemia | 21 (56.8) | 9 (52.9) | 2 (66.7) | 8 (61.5) | 2 (50.0) | 0.937 |
Diabetes mellitus | 7 (18.9) | 7 (11.8) | 2 (66.7) | 2 (15.4) | 1 (25.0) | 0.156 |
COPD | 3 (8.1) | 2 (11.8) | 0 | 0 | 1 (25.0) | 0.355 |
Cerebral vascular disease | 2 (5.4) | 1 (5.9) | 1 (33.3) | 0 | 0 | 0.135 |
Hepatic insufficiency | 2 (5.4) | 1 (5.9) | 1 (33.3) | 0 | 0 | 0.135 |
Peripheral vascular disease | 2 (5.4) | 1 (5.9) | 0 | 1 (7.7) | 0 | 0.910 |
Characteristics (n, %) | Total N = 37 | Type 1 N = 17 | Type 2 N = 3 | Type 3 N = 13 | Type 4 N = 4 | p |
---|---|---|---|---|---|---|
Valvular classification | ||||||
Tricuspid valve | 33 (89.2) | 16 (94.1) | 3 (100.0) | 11 (84.6) | 3 (75.0) | 0.574 |
Quadricuspid valve | 2 (5.4) | 1 (5.9) | 0 | 1 (7.7) | 0 | |
Bicuspid valve | 2 (5.4) | 0 | 0 | 1 (7.7) | 1 (25.1) | |
Measurement (diameter calculated by the perimeter, mm) | ||||||
Annular circumference | 81.7 ± 6.8 | 80.6 ± 5.2 | 85.3 ± 4.7 | 80.8 ± 7.1 | 86.9 ± 11.3 | 0.280 |
Annulus | 26.0 ± 2.2 | 25.6 ± 1.7 | 17.1 ± 1.5 | 15.7 ± 2.3 | 27.7 ± 3.6 | 0.284 |
LVOT | 26.9 ± 2.9 | 26.2 ± 2.0 | 28.8 ± 2.4 | 26.5 ± 2.8 | 30.1 ± 4.9 ac | 0.053 |
STJ Height | 25.67 ± 5.4 | 24.0 ± 3.2 | 30.9 ± 4.7 a | 27.5 ± 7.1 | 23.2 ± 4.0 | 0.078 |
STJ | 35.7 ± 4.9 | 32.4 ± 2.7 | 35.1 ± 4.9 | 39.9 ± 4.7 a | 36.3 ± 2.8 | 0.000 |
AA widest | 41.9 ± 6.2 | 38.6 ± 4.6 | 38.0 ± 4.7 | 47.2 ± 5.3 ab | 41.8 ± 5.5 | 0.000 |
Right coronary sinus | 36.9 ± 4.5 | 35.2 ± 3.2 | 39.5 ± 7.9 | 38.6 ± 4.5 a | 36.6 ± 5.8 | 0.156 |
Left coronary sinus | 37.6 ± 4.3 | 35.5 ± 2.9 | 42.1 ± 4.3 a | 39.4 ± 4.3 a | 37.5 ± 6.0 | 0.019 |
Non-coronary sinus | 38.2 ± 4.1 | 36.3 ± 2.8 | 41.4 ± 5.8 a | 40.1 ± 4.4 a | 37.8 ± 3.7 | 0.037 |
Left coronary height | 14.4 ± 4.0 | 14.3 ± 3.6 | 20.4 ± 4.2 a | 13.7 ± 3.7 | 12.7 ± 4.7 | 0.045 |
Right coronary height | 18.6 ± 3.4 | 18.1 ± 3.0 | 22.3 ± 3.5 | 18.4 ± 4.0 | 19.0 ± 2.6 | 0.268 |
Annulus angle | 49.7 ± 12.4 | 48.2 ± 9.0 | 49.3 ± 3.5 | 51.6 ± 17.4 | 50.3 ± 12.3 | 0.910 |
>60° | 7 (18.9) | 1 (5.9) | 0 | 5 (38.5) | 1 (25.0) | 0.092 |
50°–60° | 12 (32.4) | 4 (23.5) | 1 (33.3) | 6 (46.2) | 1 (25.0) | |
<50° | 18 (48.6) | 12 (70.6) | 2 (66.7) | 2 (15.4) | 2 (50.0) | |
Dual-anchoring multiplane measurement (diameter calculated by the perimeter, mm) | ||||||
Sup-2 mm | 26.2 ± 2.6 | 25.7 ± 1.7 | 27.5 ± 1.7 | 25.5 ± 2.3 | 29.3 ± 5.0 ac | 0.040 |
Sup-2 mm | 26.7 ± 2.0 | 26.4 ± 1.6 | 27.9 ± 1.4 | 26.7 ± 2.3 | 26.8 ± 2.9 | 0.715 |
Sup-4 mm | 28.3 ± 2.1 | 28.2 ± 1.8 | 29.4 ± 2.0 | 28.4 ± 2.5 | 27.0 ± 2.4 | 0.516 |
Sup-6 mm | 29.6 ± 2.2 | 29.4 ± 2.0 | 31.1 ± 2.0 | 29.8 ± 2.2 | 28.0 ± 2.8 | 0.295 |
Sup-8 mm | 30.5 ± 2.4 | 30.1 ± 1.7 | 31.8 ± 4.5 | 31.1 ± 2.5 | 28.8 ± 2.9 | 0.254 |
Sup-10 mm | 31.2 ± 2.6 | 30.6 ± 1.8 | 32.4 ± 5.0 | 32.2 ± 2.6 | 30.0 ± 3.0 | 0.212 |
Sup-min | 26.6 ± 2.0 | 26.4 ± 1.7 | 27.9 ± 1.4 | 26.7 ± 2.3 | 26.2 ± 2.9 | 0.686 |
AA-30 mm | 37.7 ± 5.4 | 34.2 ± 2.8 | 36.1 ± 5.8 | 42.5 ± 5.2 ab | 38.5 ± 2.6 | 0.000 |
AA-35 mm | 38.7 ± 5.4 | 35.3 ± 2.9 | 35.3 ± 4.0 | 43.6 ± 5.4 ab | 39.0 ± 2.7 c | 0.000 |
AA-40 mm | 39.7 ± 5.4 | 36.6 ± 3.1 | 36.2 ± 3.8 | 44.6 ± 5.3 ab | 39.5 ± 3.4 | 0.000 |
AA-45 mm | 40.6 ± 5.6 | 37.5 ± 3.6 | 36.9 ± 3.9 | 45.5 ± 5.4 ab | 40.7 ± 3.2 | 0.000 |
AA-50 mm | 41.6 ± 6.1 | 38.0 ± 4.1 | 37.7 ± 3.8 | 46.3 ± 5.4 ab | 44.6 ± 5.9 a | 0.000 |
AA-min | 37.5 ± 5.2 | 34.2 ± 2.8 | 34.9 ± 4.7 | 42.2 ± 4.8 ab | 37.9 ± 2.3 | 0.000 |
Characteristics (n, %) | Total N = 37 | Type 1 N = 17 | Type 2 N = 3 | Type 3 N = 13 | Type 4 N = 4 | p |
---|---|---|---|---|---|---|
Retrospective cases | 7 (18.9) | 0 | 0 | 3 (23.1) | 4 (100.0) | 0.000 |
Prospective cases | 30 (81.1) | 17 (100.0) | 3 (100.0) | 10 (76.9) | 0 | |
General anesthesia | 21 (56.8) | 10 (58.8) | 3 (100.0) | 7 (53.8) | 1 (25.0) | 0.261 |
Local anesthesia * | 16 (43.2) | 7 (41.2) | 0 | 6 (46.2) | 3 (75.0) | |
First-generation THV | 28 (75.7) | 12 (70.6) | 3 (100.0) | 9 (69.2) | 4 (100.0) | 0.426 |
Second-generation THV # | 9 (24.3) | 5 (29.4) | 0 | 4 (30.8) | 0 | |
Oversize (%) | ||||||
Annulus | 17.4 ± 7.9 | 20.4 ± 8.7 | 10.6 ± 1.7 a | 18.0 ± 4.8 | 8.0 ± 5.2 a | 0.009 |
Narrowest super-annulus | 14.7 ± 7.4 | 16.7 ± 6.7 | 7.7 ± 4.5 | 13.7 ± 7.1 | 13.9 ± 11.0 | 0.240 |
LVOT | 13.9 ± 11.3 | 17.9 ± 10.8 | 4.3 ± 5.0 a | 15.2 ± 9.6 | −0.4 ± 7.5 ac | 0.007 |
2 mm below the annulus | 17.1 ± 9.9 | 20.3 ± 9.6 | 9.3 ± 3.3 a | 19.0 ± 6.8 | 2.6 ± 8.2 a | 0.002 |
Ascending aorta | 8.3 ± 15.2 | 17.5 ± 9.9 | 19.8 ± 13.3 | −5.1 ± 11.2 ab | 4.0 ± 14.3 ab | 0.000 |
Narrowest AA | 14.7 ± 16.6 | 25.8 ± 20.7 | 25.0 ± 18.4 | −0.0 ± 11.5 ab | 7.8 ± 10.9 a | 0.000 |
Outcome | ||||||
THV downward | 6 (16.2) | 1 (5.9) | 2 (66.7) | 2 (15.4) | 1 (25.0) | 0.066 |
THV upward | 8 (21.6) | 1 (5.9) | 0 | 5 (38.5) | 2 (50.0) | 0.060 |
THV release into the artery | 5 (13.5) | 1 (2.7) | 0 | 3 (23.1) | 1 (25.0) | 0.426 |
THV pulled out of the body | 1 (2.7) | 0 | 0 | 1 (7.7) | 0 | 0.594 |
THV-in-THV implantation | 8 (21.6) | 1 (5.9) | 2 (66.7) | 3 (23.1) | 2 (50.0) | 0.046 |
PPI | 9 (24.3) | 7 (41.2) | 0 | 2 (15.4) | 0 | 0.142 |
Annular rupture | 0 | 0 | 0 | 0 | 0 | - |
Descending aortic dissection | 2 (5.4) | 0 | 0 | 2 (15.4) | 0 | 0.272 |
Death | 0 | 0 | 0 | 0 | 0 | - |
Moderate-to-severe PVL | 5 (13.5) | 0 | 0 | 4 (30.8) | 1 (25.0) | 0.076 |
Device success | 25 (67.6) | 16 (94.1) | 1 (33.3) | 6 (46.2) | 2 (50.0) | 0.016 |
Operation success | 32 (86.5) | 17 (100.0) | 3 (100.0) | 9 (69.2) | 3 (75.0) | 0.076 |
Characteristics (n,%) | Total N = 34 | Type 1 N = 17 | Type 2 N = 3 | Type 3 N = 11 | Type 4 N = 3 | p |
---|---|---|---|---|---|---|
Left ventricular ejection fraction (%) | ||||||
Preoperative | 53.1 ± 12.1 | 53.9 ± 10.1 | 41.3 ± 11.0 | 57.9 ± 12.3 b | 46.3 ± 16.3 | 0.120 |
Postoperative | 48.9 ± 10.4 | 49.3 ± 11.0 | 44.0 ± 14.4 | 52.1 ± 8.2 | 42.5 ± 9.3 | 0.382 |
1 month | 52.9 ± 9.5 | 54.7 ± 9.5 | 52.0 ± 13.5 | 51.4 ± 10.2 | 49.0 ± 7.2 | 0.701 |
3 months | 52.4 ± 10.8 | 54.0 ± 10.2 | 47.0 ± 13.9 | 51.6 ± 13.0 | 52.7 ± 7.5 | 0.804 |
6 months | 57.9 ± 8.8 n | 59.7 ± 5.2 n | 54.3 ± 15.7 | 57.0 ± 9.0 | 56.3 ± 15.3 | 0.798 |
1 year | 59.0 ± 9.2 mnoq | 61.1 ± 7.5 mn | 54.3 ± 12.9 | 55.7 ± 10.1 | 61.7 ± 11.6 n | 0.511 |
Interventricular septal thickness (mm) | ||||||
Preoperative | 10.2 ± 1.6 | 9.9 ± 1.5 | 8.7 ± 1.5 | 11.2 ± 1.2 ab | 10.0 ± 1.4 | 0.046 |
Postoperative | 10.7 ± 1.7 | 10.7 ± 1.5 | 10.7 ± 2.9 | 11.6 ± 1.3 | 9.0 ± 1.8 c | 0.079 |
1 month | 10.8 ± 2.4 | 10.4 ± 2.0 | 10.7 ± 3.1 | 12.0 ± 3.3 | 10.3 ± 1.0 | 0.466 |
3 months | 10.7 ± 2.2 | 10.5 ± 2.1 | 10.0 ± 1.0 | 11.5 ± 3.0 | 9.7 ± 0.6 | 0.580 |
6 months | 10.8 ± 1.8 | 10.5 ± 1.5 | 10.0 ± 2.0 | 11.5 ± 2.1 | 11.0 ± 2.6 | 0.655 |
1 year | 10.3 ± 2.1 | 9.8 ± 1.4 | 8.7 ± 2.1 | 11.8 ± 3.0 b | 10.7 ± 1.5 | 0.133 |
Left ventricular end-diastolic diameter (mm) | ||||||
Preoperative | 62.5 ± 7.3 | 61.4 ± 8.6 | 69.3 ± 4.0 | 62.7 ± 5.8 | 62.0 ± 4.7 | 0.393 |
Postoperative | 56.4 ± 7.5 m | 54.7 ± 8.7 m | 60.3 ± 7.6 m | 56.4 ± 4.5 m | 61.3 ± 7.0 | 0.339 |
1 month | 54.3 ± 6.9 m | 52.6 ± 6.5 m | 59.7 ± 6.0 m | 54.1 ± 4.9 m | 58.3 ± 11.0 | 0.251 |
3 months | 52.9 ± 5.5 mn | 51.3 ± 4.1 m | 57.7 ± 3.2 m | 53.6 ± 6.7 m | 53.3 ± 8.5 | 0.338 |
6 months | 50.1 ± 6.1 mno | 48.6 ± 6.8 mn | 56.7 ± 3.2 m | 49.5 ± 4.6 mn | 49.3 ± 6.7 m | 0.250 |
1 year | 49.9 ± 6.4 mno | 48.8 ± 7.2 mn | 53.0 ± 5.2 m | 49.2 ± 6.0 mn | 53.0 ± 5.2 | 0.623 |
N-terminal pro–B-type natriuretic peptide (pg/mL) | ||||||
Preoperative | 3481.4 ± 6419.5 | 2647.0 ± 5601.6 | 4594.7 ± 5298.8 | 1267.2 ± 1234.7 | 11,728.6 ± 12,265.7 ac | 0.034 |
Postoperative | 1495.1 ± 1275.0 m | 1457.6 ± 1345.8 | 1932.3 ± 1580.9 | 1083.2 ± 863.0 | 2356.5 ± 1602.1 m | 0.369 |
1 month | 1605.0 ± 1446.0 m | 755.1 ± 1145.0 | 2360.3 ± 3533.2 | 863.0 ± 817.0 | 1609.1 ± 1045.2 m | 0.294 |
3 months | 934.4 ± 1293.8 m | 748.1 ± 1047.2 | 2050.0 ± 3026.0 | 710.2 ± 600.5 | 1070.5 ± 936.9 | 0.468 |
6 months | 1038.3 ± 1862.9 m | 671.0 ± 762.7 | 2786.4 ± 4512.5 | 760.3 ± 1133.5 | 703.3 ± 679.0 m | 0.396 |
1 year | 672.0 ± 929.3 m | 712.6 ± 1127.7 | 875.2 ± 1162.8 | 323.5 ± 342.6 m | 1383.5 ± 1130.7 | 0.539 |
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Chen, Y.; Ferdous, M.M.; Kottu, L.; Zhao, J.; Zhang, H.-L.; Wang, M.-Y.; Niu, G.-N.; Liu, Q.-R.; Zhou, Z.; Zhao, Z.-Y.; et al. Can Measuring the ‘Dual Anchors of Aorta’ Enhance the Success Rate of TAVR?—A Single-Center Experience. J. Clin. Med. 2023, 12, 1157. https://doi.org/10.3390/jcm12031157
Chen Y, Ferdous MM, Kottu L, Zhao J, Zhang H-L, Wang M-Y, Niu G-N, Liu Q-R, Zhou Z, Zhao Z-Y, et al. Can Measuring the ‘Dual Anchors of Aorta’ Enhance the Success Rate of TAVR?—A Single-Center Experience. Journal of Clinical Medicine. 2023; 12(3):1157. https://doi.org/10.3390/jcm12031157
Chicago/Turabian StyleChen, Yang, Md Misbahul Ferdous, Lakshme Kottu, Jie Zhao, Hong-Liang Zhang, Mo-Yang Wang, Guan-Nan Niu, Qing-Rong Liu, Zheng Zhou, Zhen-Yan Zhao, and et al. 2023. "Can Measuring the ‘Dual Anchors of Aorta’ Enhance the Success Rate of TAVR?—A Single-Center Experience" Journal of Clinical Medicine 12, no. 3: 1157. https://doi.org/10.3390/jcm12031157