A patient-specific algorithm to achieve commissural alignment with Acurate Neo: The sextant technique

被引：15

作者：

De Marco, Federico ^{[1
]}

Casenghi, Matteo ^{[1
,2
]}

Spagnolo, Pietro ^{[1
]}

Popolo Rubbio, Antonio ^{[1
]}

Brambilla, Nedy ^{[1
]}

Testa, Luca ^{[1
]}

Bedogni, Francesco ^{[1
]}

机构：

[1] IRCCS Policlin San Donato, Clin & Intervent Cardiol Dept, San Donato Milanese, Italy

[2] Univ Rome Sapienza, Sch Med & Psychol, Dept Clin & Mol Med, Rome, Italy

来源：

CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS | 2021年 / 98卷 / 06期

关键词：

coronary access; commissural alignment; TAVR; TAV‐ in‐ TAV;

D O I：

10.1002/ccd.29737

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Aims The aim of this proof-of-concept study was to investigate safety and efficacy of a CT-scan based patient-specific algorithm to maximize coronary clearance and secondarily to achieve anatomically correct commissural alignment with the Acurate Neo device. Method and results A total of 45 consecutive patients undergoing TAVR with the Acurate Neo THV were prospectively enrolled in the study. Mean age was 81.6 +/- 5.5 years, mean STS score was 6.1 +/- 3.7. Device success rate was 100%. Aim of the technique was to rotationally deploy the TAVR device with a commissure lying on the bisector between the coronary ostia as calculated on the pre-procedural CT-scan. At post-TAVR CT-scan, coronary clearance was achieved in 98% of patients with no cases of severe coronary artery overlap. In 42 out of 45 patients, THV was aligned or, at most, mildly misaligned; there were 2 cases of moderate misalignment without any case of severe misalignment. Post-TAVR selective coronary artery engagement was attempted and succeeded in all patients (100%). Conclusion Our CT-scan based patient-specific algorithm is safe and proven to be effective in avoiding coronary artery overlap and providing commissural alignment with Acurate Neo in all treated patients.

引用

页码：E847 / E854

页数：8

共 11 条

[1] The impact of imperfect frame deployment and rotational orientation on stress within the prosthetic leaflets during transcatheter aortic valve implantation [J].

Bailey, Jonathon ;

Curzen, Nick ;

Bressloff, Neil W. .

JOURNAL OF BIOMECHANICS, 2017, 53 :22-28

[2] Commissural Alignment of Bioprosthetic Aortic Valve and Native Aortic Valve Following Surgical and Transcatheter Aortic Valve Replacement and its Impact on Valvular Function and Coronary Filling [J].

Fuchs, Andreas ;

Kofoed, Klaus F. ;

Yoon, Sung-Han ;

Schaffner, Yannick ;

Bieliauskas, Gintautas ;

Thyregod, Hans Gustav ;

Makkar, Raj ;

Sondergaard, Lars ;

De Backer, Ole ;

Bapat, Vinayak .

JACC-CARDIOVASCULAR INTERVENTIONS, 2018, 11 (17) :1733-1743

[3] Impact of aortic angle on transcatheter aortic valve implantation outcome with Evolut-R, Portico, and Acurate-NEO [J].

Gorla, Riccardo ;

De Marco, Federico ;

Garatti, Andrea ;

Bianchi, Giovanni ;

Popolo Rubbio, Antonio ;

Acerbi, Elena ;

Casenghi, Matteo ;

Spagnolo, Pietro ;

Brambilla, Nedy ;

Testa, Luca ;

Agnifili, Mauro L. ;

Tusa, Maurizio ;

Bedogni, Francesco .

CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, 2021, 97 (01) :E135-E145

[4] Simulation of Self Expanding Transcatheter Aortic Valve in a Realistic Aortic Root: Implications of Deployment Geometry on Leaflet Deformation [J].

Gunning, Paul S. ;

Vaughan, Ted J. ;

McNamara, Laoise M. .

ANNALS OF BIOMEDICAL ENGINEERING, 2014, 42 (09) :1989-2001

[5]

Kappetein AP, 2012, J AM COLL CARDIOL, V60, P1438, DOI [10.1093/ejcts/ezs533, 10.1016/j.jacc.2012.09.001]

[6] The BASILICA Trial Prospective Multicenter Investigation of Intentional Leaflet Laceration to Prevent TAVR Coronary Obstruction [J].

Khan, Jaffar M. ;

Greenbaum, Adam B. ;

Babaliaros, Vasilis C. ;

Rogers, Toby ;

Eng, Marvin H. ;

Paone, Gaetano ;

Leshnower, Bradley G. ;

Reisman, Mark ;

Satler, Lowell ;

Waksman, Ron ;

Chen, Marcus Y. ;

Stine, Annette M. ;

Tian, Xin ;

Dvir, Danny ;

Lederman, Robert J. .

JACC-CARDIOVASCULAR INTERVENTIONS, 2019, 12 (13) :1240-1252

[7] Transcatheter Aortic-Valve Replacement with a Balloon-Expandable Valve in Low-Risk Patients [J].

Mack, M. J. ;

Leon, M. B. ;

Thourani, V. H. ;

Makkar, R. ;

Kodali, S. K. ;

Russo, M. ;

Kapadia, S. R. ;

Malaisrie, S. C. ;

Cohen, D. J. ;

Pibarot, P. ;

Leipsic, J. ;

Hahn, R. T. ;

Blanke, P. ;

Williams, M. R. ;

McCabe, J. M. ;

Brown, D. L. ;

Babaliaros, V. ;

Goldman, S. ;

Szeto, W. Y. ;

Genereux, P. ;

Pershad, A. ;

Pocock, S. J. ;

Alu, M. C. ;

Webb, J. G. ;

Smith, C. R. .

NEW ENGLAND JOURNAL OF MEDICINE, 2019, 380 (18) :1695-1705

[8] Coronary Access After TAVR [J].

Ochiai, Tomoki ;

Chakravarty, Tarun ;

Yoon, Sung-Han ;

Kaewkes, Danon ;

Flint, Nir ;

Patel, Vivek ;

Mahani, Sahar ;

Tiwana, Ripandeep ;

Sekhon, Navjot ;

Nakamura, Mamoo ;

Cheng, Wen ;

Makkar, Raj .

JACC-CARDIOVASCULAR INTERVENTIONS, 2020, 13 (06) :693-705

[9] Transcatheter Aortic-Valve Replacement with a Self-Expanding Valve in Low-Risk Patients [J].

Popma, Jeffrey J. ;

Deeb, G. Michael ;

Yakubov, Steven J. ;

Mumtaz, Mubashir ;

Gada, Hemal ;

O'Hair, Daniel ;

Bajwa, Tanvir ;

Heiser, John C. ;

Merhi, William ;

Kleiman, Neal S. ;

Askew, Judah ;

Sorajja, Paul ;

Rovin, Joshua ;

Chetcuti, Stanley J. ;

Adams, David H. ;

Teirstein, Paul S. ;

Zorn, George L., III ;

Forrest, John K. ;

Tchetche, Didier ;

Resar, Jon ;

Walton, Antony ;

Piazza, Nicolo ;

Ramlawi, Basel ;

Robinson, Newell ;

Petrossian, George ;

Gleason, Thomas G. ;

Oh, Jae K. ;

Boulware, Michael J. ;

Qiao, Hongyan ;

Mugglin, Andrew S. ;

Reardon, Michael J. .

NEW ENGLAND JOURNAL OF MEDICINE, 2019, 380 (18) :1706-1715

[10] Alignment of Transcatheter Aortic -Valve Neo-Commissures (ALIGN TAVR) Impact on Final Valve Orientation and Coronary Artery Overlap [J].

Tang, Gilbert H. L. ;

Zaid, Syed ;

Fuchs, Andreas ;

Yamabe, Tsuyoshi ;

Yazdchi, Farhang ;

Gupta, Eisha ;

Ahmad, Hasan ;

Kofoed, Klaus F. ;

Goldberg, Joshua B. ;

Undemir, Cenap ;

Kaple, Ryan K. ;

Shah, Pinak B. ;

Kaneko, Tsuyoshi ;

Lansman, Steven L. ;

Khera, Sahil ;

Kovacic, Jason C. ;

Dangas, George D. ;

Lerakis, Stamatios ;

Sharma, Samin K. ;

Kini, Annapoorna ;

Adams, David H. ;

Khalique, Omar K. ;

Hahn, Rebecca T. ;

Sondergaard, Lars ;

George, Isaac ;

Kodali, Susheel K. ;

De Backer, Ole ;

Leon, Martin B. ;

Bapat, Vinayak N. .

JACC-CARDIOVASCULAR INTERVENTIONS, 2020, 13 (09) :1030-1042

← 1 2 →