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JACC:比较不同经导管心脏瓣膜设计的瓣中瓣TAVR及生物瓣折断

2019-01-09 xiangting MedSci原创

在VIV TAVR后进行BVF可以改善残余梯度。BVF之后,无论THV设计如何,残余梯度都是相似的。

这项研究旨在评估瓣中瓣(VIV)经导管主动脉瓣置换术(TAVR)后生物瓣折断(BVF)的效果,并在体外基准研究中测试不同的经导管心脏瓣膜(THV)设计。

目前通过生物瓣折断来改善VIV TAVR后的残余跨瓣梯度。

研究人员评估了使用SAPIEN 3(S3)(爱德华生命科学,欧文,加州)和ACURATE neo(波士顿科学公司,内蒂克,马萨诸塞州)THV进行的VIV TAVR和BVF。在19毫米和21毫米的Mitroflow(美国索林集团,阿瓦达,科罗拉多州)中分别使用了20毫米和23毫米的S3。测试的两种尺寸Mitroflow中使用小型ACURATE neo。VIV TAVR样本在BVF之前和之后接受多模式成像和血流动力学评估。

需要进行高位植入以使ACURATE neo的上方冠完全扩张,并有最佳的瓣叶功能。还观察到手术瓣膜内THV的下方冠明显扩张不足。BVF之前,使用任一种THV设计的19毫米Mitroflow的VIV TAVR跨瓣梯度较高(22.0mmHg S3,19.1mmHg ACURATE neo)。BVF之后,梯度改善并且两种THVs相似(14.2mmHg S3,13.8mmHg ACURATE neo)。S3的有效孔面积在BVF后由1.2增至1.6cm2,ACURATE neo从1.4增至1.6 cm2。BVF之前,在21毫米 Mitroflow中使用ACURATE neo的VIV TAVR梯度低于S3(11.3mmHg vs.16mmHg)。然而,BVF后两种THVs的瓣膜梯度相似(8.4mmHg ACURATE neo vs. 7.8mmHg S3)。S3 的有效孔面积从1.5增至2.1cm2,ACURATE neo从1.8增至2.2cm2。

在VIV TAVR后进行BVF可以改善残余梯度。BVF之后,无论THV设计如何,残余梯度都是相似的。在小(≤21mm)手术瓣膜中使用小型ACURATE neo用于VIV TAVR可能与达到最佳THV位置和扩张存在挑战有关。在选定的临床病例中可以考虑进行BVF。

原始出处:

Janarthanan Sathananthan. Valve-in-Valve Transcatheter Aortic Valve Replacement and Bioprosthetic Valve Fracture Comparing Different Transcatheter Heart Valve DesignsAn Ex Vivo Bench Study. JACC:Cardiovascular Interventions. 14 January 2019.

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    2019-07-11 huangdf
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    2019-01-28 hbwxf
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  7. [GetPortalCommentsPageByObjectIdResponse(id=1970223, encodeId=ed2419e02238b, content=<a href='/topic/show?id=586868e5793' target=_blank style='color:#2F92EE;'>#瓣中瓣#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=68757, encryptionId=586868e5793, topicName=瓣中瓣)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e2e0330, createdName=huangdf, createdTime=Thu Jul 11 00:21:00 CST 2019, time=2019-07-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1715954, encodeId=09521e15954ed, content=<a href='/topic/show?id=2c375156e5f' target=_blank style='color:#2F92EE;'>#心脏瓣膜#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=44, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=51567, encryptionId=2c375156e5f, topicName=心脏瓣膜)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=55683, createdName=仁医06, createdTime=Mon Jul 08 15:21:00 CST 2019, time=2019-07-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1854281, encodeId=22f61854281e8, content=<a href='/topic/show?id=48351020537' target=_blank style='color:#2F92EE;'>#JACC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=10205, encryptionId=48351020537, topicName=JACC)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=55ce62, createdName=hbwxf, createdTime=Mon Jan 28 18:21:00 CST 2019, time=2019-01-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1635556, encodeId=887b163555618, content=<a href='/topic/show?id=83a3693965d' target=_blank style='color:#2F92EE;'>#生物瓣#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=49, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=69396, encryptionId=83a3693965d, topicName=生物瓣)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ddce22497218, createdName=396094184_42047362, createdTime=Wed Jan 16 19:21:00 CST 2019, time=2019-01-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2086355, encodeId=a9f9208635525, content=<a href='/topic/show?id=134b304456' target=_blank style='color:#2F92EE;'>#AVR#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=3044, encryptionId=134b304456, topicName=AVR)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7d74253, createdName=wangtianj2007@, createdTime=Mon Aug 12 02:21:00 CST 2019, time=2019-08-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1326095, encodeId=8c851326095fd, content=<a href='/topic/show?id=96c71804b7' target=_blank style='color:#2F92EE;'>#ACC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1804, encryptionId=96c71804b7, topicName=ACC)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1e452500029, createdName=12498568m50暂无昵称, createdTime=Fri Jan 11 07:21:00 CST 2019, time=2019-01-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1510190, encodeId=39191510190da, content=<a href='/topic/show?id=e9bce8254ef' target=_blank style='color:#2F92EE;'>#经导管#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=78254, encryptionId=e9bce8254ef, topicName=经导管)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=93e010191378, createdName=lsj631, createdTime=Fri Jan 11 07:21:00 CST 2019, time=2019-01-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1583606, encodeId=86a4158360688, content=<a href='/topic/show?id=508d68e698c' target=_blank style='color:#2F92EE;'>#瓣膜#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=68769, encryptionId=508d68e698c, topicName=瓣膜)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=58dc16986228, createdName=12498e5fm17(暂无昵称), createdTime=Fri Jan 11 07:21:00 CST 2019, time=2019-01-11, status=1, ipAttribution=)]
    2019-01-11 lsj631
  8. [GetPortalCommentsPageByObjectIdResponse(id=1970223, encodeId=ed2419e02238b, content=<a href='/topic/show?id=586868e5793' target=_blank style='color:#2F92EE;'>#瓣中瓣#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=68757, encryptionId=586868e5793, topicName=瓣中瓣)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e2e0330, createdName=huangdf, createdTime=Thu Jul 11 00:21:00 CST 2019, time=2019-07-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1715954, encodeId=09521e15954ed, content=<a href='/topic/show?id=2c375156e5f' target=_blank style='color:#2F92EE;'>#心脏瓣膜#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=44, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=51567, encryptionId=2c375156e5f, topicName=心脏瓣膜)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=55683, createdName=仁医06, createdTime=Mon Jul 08 15:21:00 CST 2019, time=2019-07-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1854281, encodeId=22f61854281e8, content=<a href='/topic/show?id=48351020537' target=_blank style='color:#2F92EE;'>#JACC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=10205, encryptionId=48351020537, topicName=JACC)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=55ce62, createdName=hbwxf, createdTime=Mon Jan 28 18:21:00 CST 2019, time=2019-01-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1635556, encodeId=887b163555618, content=<a href='/topic/show?id=83a3693965d' target=_blank style='color:#2F92EE;'>#生物瓣#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=49, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=69396, encryptionId=83a3693965d, topicName=生物瓣)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ddce22497218, createdName=396094184_42047362, createdTime=Wed Jan 16 19:21:00 CST 2019, time=2019-01-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2086355, encodeId=a9f9208635525, content=<a href='/topic/show?id=134b304456' target=_blank style='color:#2F92EE;'>#AVR#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=3044, encryptionId=134b304456, topicName=AVR)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7d74253, createdName=wangtianj2007@, createdTime=Mon Aug 12 02:21:00 CST 2019, time=2019-08-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1326095, encodeId=8c851326095fd, content=<a href='/topic/show?id=96c71804b7' target=_blank style='color:#2F92EE;'>#ACC#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1804, encryptionId=96c71804b7, topicName=ACC)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1e452500029, createdName=12498568m50暂无昵称, createdTime=Fri Jan 11 07:21:00 CST 2019, time=2019-01-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1510190, encodeId=39191510190da, content=<a href='/topic/show?id=e9bce8254ef' target=_blank style='color:#2F92EE;'>#经导管#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=78254, encryptionId=e9bce8254ef, topicName=经导管)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=93e010191378, createdName=lsj631, createdTime=Fri Jan 11 07:21:00 CST 2019, time=2019-01-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1583606, encodeId=86a4158360688, content=<a href='/topic/show?id=508d68e698c' target=_blank style='color:#2F92EE;'>#瓣膜#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=68769, encryptionId=508d68e698c, topicName=瓣膜)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=58dc16986228, createdName=12498e5fm17(暂无昵称), createdTime=Fri Jan 11 07:21:00 CST 2019, time=2019-01-11, status=1, ipAttribution=)]
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