Anatomical morphology of the aortic valve in Chinese aortic stenosis patients and clinical results after downsize strategy of transcatheter aortic valve replacement  

作　　者：Guannan Niu Walid Ben Ali Moyang Wang Hasan Jilaihawi Haitong Zhang Qian Zhang Yunqing Ye Xinmin Liu Jing Yao Qinghao Zhao Yubin Wang Zheng Zhou Lizhi Zhang Xinshuang Ren Yunqiang An Bin Lu Thomas Modine Yongjian Wu Guangyuan Song 

机构地区：[1]Department of Cardiology,Fuwai Hospital,National Center for Cardiovascular Disease,Chinese Academy of Medical Science and Peking Union Medical College,Beijing 100037,China [2]Structural Heart Intervention Program,Department of Surgery,Montreal Heart Institute,Montreal H1T 1C8,Quebec,Canada [3]Heart Valve Center,NYU Langone Health,New York,NY 10016,USA [4]Interventional Center of Valvular Heart Disease,Anzhen Hospital Affiliate of Capital University of Medical Sciences,Beijing 100029,China [5]Eagles Corelab.,YingKe Medical(Beijing)Co.,Ltd,Beijing 100160,China [6]Department of Radiology,Fuwai Hospital,National Center for Cardiovascular Diseases,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100037,China [7]Service Médico-Chirurgical:Valvulopathies-Chirurgie Cardiaque-Cardiologie Interventionelle Structurelle,Hôpital Cardiologique de Haut Lévèque,CHU Bordeaux,Bordeaux 33000,France

出　　处：《Chinese Medical Journal》2022年第24期2968-2975,共8页中华医学杂志（英文版）

基　　金：National Key Research&Development Program of China(No.2020YFC2008100);Project of Capital Clinical Treatment Technology Research and Translation Application(No.Z201100005520068)。

摘　　要：Background:The study aimed to describe the aortic valve morphology in Chinese patients underwent transcatheter aortic valve replacement(TAVR)for symptomatic severe aortic stenosis(AS),and the impact of sizing strategies and related procedural outcomes.Methods:Patients with severe AS who underwent TAVR were consecutively enrolled from 2012 to 2019.The anatomy and morphology of the aortic root were assessed."Downsize"strategy was preformed when patients had complex morphology.The clinical outcomes of patients who performed downsize strategy were compared with those received annular sizing strategy.The primary outcome was device success rate,and secondary outcomes included Valve Academic Research Consortium-3 clinical outcomes variables based on 1-year follow-up.Results:A total of 293 patients were enrolled.Among them,95 patients(32.4%)had bicuspid aortic valve.The calcium volume(Hounsfield Unit-850)of aortic root was 449.90(243.15-782.15)mm3.Calcium is distributed mostly on the leaflet level.Downsize strategy was performed in 204 patients(69.6%).Compared with the patients who performed annular sizing strategy,those received downsize strategy achieved a similar device success rate(82.0%[73]vs.83.3%[170],P=0.79).Aortic valve gradients(downsize strategy group vs.annular sizing group,11.28 mmHg vs.11.88 mmHg,P=0.64)and percentages of patients with moderate or severe paravalvular regurgitation 2.0%(4/204)vs.4.5%(4/89),P=0.21were similar in the two groups at 30 days after TAVR.These echocardiographic results were sustainable for one year.Conclusions:Chinese TAVR patients have more prevalent bicuspid morphology and large calcium volume of aortic root.Calcium is distributed mostly on the leaflet level.Compare with annular sizing strategy,downsize strategy provided a non-inferior device success rate and transcatheter heart valve hemodynamic performance in self-expanding TAVR procedure.

关 键 词：Aortic stenosis China Sizing strategy Transcatheter aortic valve replacement Aortic valve MORPHOLOGY 

分 类 号：R542.52[医药卫生—心血管疾病]