Impact of Commissural Misalignment on Hydrodynamic Function Following Valve-in-Valve Intervention With the ACURATE neo,JACC: Cardiovascular Interventions

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Impact of Commissural Misalignment on Hydrodynamic Function Following Valve-in-Valve Intervention With the ACURATE neo
JACC: Cardiovascular Interventions ( IF 11.7 ) Pub Date : 2022-07-13 , DOI: 10.1016/j.jcin.2022.05.034
David Meier ₁ , Mariama Akodad ₁ , Andrew G Chatfield ₁ , Georg Lutter ₂ , Thomas Puehler ₂ , Lars Søndergaard ₃ , David A Wood ₄ , John G Webb ₄ , Stephanie L Sellers ₅ , Janarthanan Sathananthan ₅

Affiliation

Background

Limited evidence is available regarding valve-in-valve (VIV) intervention with the ACURATE neo transcatheter heart valve (THV). Low implantation has demonstrated leaflet interaction between the surgical bioprosthesis and the THV, leading to impaired hydrodynamic performance. It is unknown if commissural alignment (CA) can affect this phenomenon. Novel techniques have now been developed to achieve CA with the ACURATE neo THV.

Objectives

The aim of this study was to assess the impact of commissural misalignment (CMA) on hydrodynamic function following VIV intervention with the ACURATE neo THV using a bench model.

Methods

VIV intervention was performed with the ACURATE neo (a self-expanding THV with supra-annular leaflet position) implanted deep in the surgical bioprosthetic aortic valve (Mitroflow). Hydrodynamic function at CA (0°) and 3 different degrees of CMA (30°, 60°, and 90°) was tested. As per the International Organization for Standardization, a regurgitant fraction <20% is considered optimal.

Results

Following VIV, the central THV regurgitant fraction at 0°, 30°, 60°, and 90° of CMA was 8.6% ± 2.0%, 30.3% ± 12.0%, 42.6% ± 11.9%, and 66.7% ± 25.4% (P < 0.0001), respectively. On high-speed video there was no evidence of leaflet interaction at CA, whereas at 30°, 60°, and 90° of CMA there was clear evidence of THV leaflet interaction with those of the surgical valve, leading to impaired leaflet closure and to severe central THV regurgitation.

Conclusions

In VIV using the ACURATE neo THV at deep implantation, increasing degree of CMA was associated with THV leaflet interaction with those of the surgical valve and worsening regurgitant fraction. THV leaflet interaction was prevented when there was CA.

中文翻译：

使用 ACURATE neo 进行阀中阀干预后连合错位对流体动力功能的影响

背景

关于使用 ACURATE neo 经导管心脏瓣膜 (THV) 进行瓣中瓣 (VIV) 干预的证据有限。低植入已证明手术生物假体和 THV 之间的小叶相互作用，导致流体动力学性能受损。不知道连合对齐 (CA) 是否会影响这种现象。现在已经开发出新技术来使用 ACURATE neo THV 实现 CA。

目标

本研究的目的是评估在使用 ACURATE neo THV 进行 VIV 干预后，连合错位 (CMA) 对流体动力学功能的影响。

方法

VIV 干预是通过植入外科生物人工主动脉瓣 (Mitroflow) 深处的 ACURATE neo（具有超瓣环位置的自扩张 THV）进行的。测试了 CA (0°) 和 3 个不同程度的 CMA (30°、60° 和 90°) 的水动力函数。根据国际标准化组织，反流分数 <20% 被认为是最佳的。

结果

VIV 后，CMA 0°、30°、60° 和 90° 的中央 THV 反流分数分别为 8.6% ± 2.0%、30.3% ± 12.0%、42.6% ± 11.9% 和 66.7% ± 25.4%（P < 0.0001)，分别。在高速视频中，CA 处没有小叶相互作用的证据，而在 CMA 的 30°、60° 和 90° 处，有明显的证据表明 THV 小叶与手术瓣膜的小叶相互作用，导致小叶闭合受损和严重的中央 THV 反流。