| Background:The success of transcatheter aortic valve replacement(TAVR)in native aortic regurgitation(AR)is limited by the absence of calcified anchoring structures.We sought to evaluate transfemoral TAVR in patients with native AR using a novel aortic root imaging classification.Methods:From March to November 2021,81 patients with severe AR were prospectively enrolled in 2 cardiac centers in China.All were evaluated using multidetector computed tomography and classified into 4 anatomic types in reference to transcatheter heart valve(THV)anchoring:Type 1:anchoring at the left ventricular outflow tract(LVOT),annulus,and ascending aorta(AA);Type 2:anchoring at the annulus and AA;Type 3:anchoring at the annulus and LVOT;and Type 4:anchoring at only 1 level or none at all.Based on the dual-anchoring strategy,patients with Types 1-3 were considered TAVR candidates.Procedural and 30-day outcomes were assessed according to Valve Academic Research Consortium-3 definitions.Results:TAVR was performed in 32(39.5%)patients(71.9±8.0 years of age,71.9%were male)using 2 self-expanding THVs.Types 1,2,and 3 comprised 13(40.6%),11(34.4%),and 8(25.0%)cases,respectively.The procedural and device success rates were 100%and 93.8%,respectively,with 2 THV migration.Eight patients(25.0%)required a permanent pacemaker,and 2(6.3%)developed moderate paravalvular leaks.No deaths or other major complications occurred during the study.Conclusions:The novel anatomic classification and dual-anchoring strategy were associated with a high procedural success rate with favorable short-term safety and clinical outcomes.Purpose:This study analyzed computed tomography(CT)measurement characteristics and anatomical classifications based on transcatheter aortic valve replacement(TAVR)in patients with aortic regurgitation(AR)to establish a preliminary summary of CT anatomical characteristics and to design a novel self-expanding transcatheter heart valve(THV).Methods:This single-center retrospective cohort study included 136 patients diagnosed with moderate-to-severe AR at Fuwai Hospital from July 2017 to April 2022.Patients were classified into four anatomical classifications according to dual-anchoring multiplanar measurement of where THV anchoring took place.Types 1-3 were considered candidates for TAVR,whereas type 4 was not.Results:Among 136 patients with AR,there were 117(86.0%)tricuspid,14 bicuspid,and five quadricuspid valves.Dual-anchoring multiplanar measurement showed that the annulus was smaller than left ventricular outflow tract(LVOT)at 2,4,6,8,and 10mm on the annulus.The ascending aorta(AA)40mm was wider than AA 30mm and AA 35mm,but narrower than AA 45mm and AA 50mm.For 10%oversize of the THV,the proportions of the annulus,LVOT,and AA unable to meet the diameter were 22.8%,37.5%,and 50.0%,respectively,and the proportions of anatomical classification types 14 were 32.4%,5.9%,30.1%,and 31.6%,respectively.The novel THV could significantly improve the type 1 proportion(88.2%).Conclusion:Existing THVs cannot meet the anatomical characteristics of patients with AR.Conversely,based on anatomical characteristics,the novel THV could theoretically facilitate TAVR.Background:Chronic severe aortic regurgitation(AR)has a poor long-term prognosis,especially among old-age patients.Considering their advancing age,the surgical approach of aortic valve replacement may not always be the best alternative modality of treatment in such patients.Therefore,this study’s primary goal was to provide an initial summary of the medi-um-and short-term clinical effectiveness of transcatheter aortic valve replacement(TAVR)guided by accurate multi-detector computed tomography(MDCT)measurements in patients with severe and chronic AR,especially in elderly patients.Methods:The study enrolled retro-spectively and prospectively patients diagnosed with severe AR who eventually underwent TAVR procedure from January 2019 to September 2022 at Fuwai cardiovascular Hospital,Bei-jing.Baseline information,MDCT measurements,anatomical classification,perioperative,and 1-year follow-up outcomes were collected and analyzed.Based on a novel anatomical categori-zation and dual anchoring theory,patients were divided into four categories according to the level of anchoring area.Type 1,2,and 3 patients(with at least two anchoring regions)will receive TAVR with a transcatheter heart valve(THV),but Type 4 patients(with zero or one an-choring location)will be deemed unsuitable for TAVR and will instead receive medical care(retrospectively enrolled patients who already underwent TAVR are an exception).Results:Results:The mean age of the 37 patients with severe chronic AR was 73.1 ± 8.7 years,and 23 patients(62.2%)were male.The American Association of Thoracic Surgeons’ score was 8.6± 2.1%.The MDCT anatomical classification included 17 cases of type 1(45.9%),3 cases of type 2(8.1%),13 cases of type 3(35.1%),and 4 cases of Type 4(10.8%).The VitaFlow valve(MicroPort,Shanghai,China)was implanted in 19 patients(51.3%),while the Venus A valve(Venus MedTech,Hangzhou,China)was implanted in 18 patients(48.6%).Immediate TAVR procedural and device success rates were 86.5%and 67.6%,respectively,while eight cases(21.6%)required THV-inTHV im-plantation,and nine cases(24.3%)required permanent pacemaker implantation.Univariate re-gression analysis revealed that the major factors affecting TAVR device failure were sinotubu-lar junction diameter,THV type,and MDCT anatomical classification(p<0.05).Compared with the baseline,the left ventricular ejection fraction gradually increased,while the left ventric-ular end-diastolic diameter remained small,and the N-terminal-pro hormone B-type natriuret-ic peptide level significantly decreased within one year.Conclusion:According to the results of our study,TAVR with a self-expanding THV is safe and feasible for patients with chronic se-vere AR,particularly for those who meet the criteria for the appropriate MDCT anatomical clas-sification with intact dual aortic anchors,and it has a significant clinical effect for at least a year. |
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