- 期刊
Quantification of Stent Creep by Three-Dimensional Transesophageal Echocardiography in Patients Undergoing Transcatheter Aortic Valve-in-Valve Implantation for Failed Bioprostheses
摘要
Background: Transcatheter aortic valve-in-valve implantation (aVIV) has been used to treat bioprosthetic failure due to ＂stent creep＂, defined as inward flexion or bending of stent posts. The aim of this study was to develop quantitative three-dimensional transesophageal echocardiography (3D-TEE) geometric analysis of failed bioprostheses to determine the incidence of stent creep in patients undergoing aVIV and its contribution to the hemodynamics of those valves. Methods: We retrospectively examined the 3D-TEE of 22 consecutive patients (age 74.4 ± 11.3 years; M/F = 12/10) who underwent aVIV for failed bioprostheses. The modes of bioprosthesis failure included stenosis (n = 8), regurgitation (n = 9), and combined (n = 5). The degree of stent creep was assessed by calculating the triangular area obtained by projecting the apex of stent posts on a reconstructed plane. This measured area was divided by that of the regular triangle defined by the base of stent posts to calculate a ratio, which we termed the ＂stent creep ratio＂ (SCR). Results: The mean SCR was lower in the patients with failed prostheses than that in the controls (0.82 ± 0.16 vs. 0.96 ± 0.05, p = 0.02). The SCR was negatively correlated with the peak trans-aortic pressure gradient (r = -0.62, p ＜ 0.01). An SCR cut-off point of 0.79 was associated with aortic peak velocity ＞ 4 m/s (AUC = 0.81, sensitivity = 0.79, specificity = 0.83). Fourteen of the 22 patients had pre- and post-aVIV 3D-TEE, and the SCR was corrected satisfactorily from 0.81 ± 0.13 to 1.04 ± 0.19 (p ＜ 0.01). Conclusions: SCR measured by 3D-TEE is feasible to quantitatively evaluate stent creep. Stent creep is an important mode of structural deterioration in surgical bioprostheses, which can be treated by aVIV.
延伸閱讀
- Chan, K. C., Lin, Z. Y., Chen, T. H., Huang, Y. C., Wang, M. J., & Tsait, S. K. (2002). Transesophageal Echocardiographic Monitoring of Critical Left Ventricular Outflow Tract Obstruction Following Mitral Xenograft Replacement -A Case Report. Acta Anaesthesiologica Sinica, 40(2), 81-84. https://doi.org/10.6955/AAS.200206.0081
- Wang, B., Wang, Z., He, B., Fu, G., Feng, M., Liu, J., Yu, Y., Du, X., & Chu, H. (2021). Percutaneous Left Atrial Appendage Closure Confirmed by Intra-Procedural Transesophageal Echocardiography under Local Anesthesia: Safety and Clinical Efficacy. Acta Cardiologica Sinica, 37(2), 146-154. https://doi.org/10.6515/ACS.202103_37(2).20200327A
- Kuo, C. C., Chang, H. H., Leu, H. B., Chen, I. M., Chen, P. L., Lin, S. M., & Chen, Y. H. (2023). Outcomes and Hemodynamic Performances of Transcatheter Aortic Valve Replacement with Two Generations of Self-Expanding Transcatheter Aortic Valves. Acta Cardiologica Sinica, 39(3), 449-456. https://doi.org/10.6515/ACS.202305_39(3).20221109A
- Chen, Y. H., Chang, H. H., Chen, P. L., Weng, Z. C., Chen, I. M., Leu, H. B., Huang, C. Y., Lin, S. M., & Wu, M. H. (2017). Procedural Characteristics and Outcomes of Transcatheter Aortic Valve Implantation: A Single-Center Experience of the First 100 Inoperable or High Surgical Risk Patients with Severe Aortic Stenosis. Acta Cardiologica Sinica, 33(4), 339-349. https://doi.org/10.6515/ACS20170620A
- 陳豐霖（2007）。The Role of Real-Time Three-Dimensional Echocardiography in Congenital Septal Defects: Assessing and Guiding the Treatment Procedures for Atrial Septal Defect and Ventricular Septal Defect〔博士論文，中山醫學大學〕。華藝線上圖書館。https://doi.org/10.6834/CSMU.2007.00009