Accurate commissural alignment during ACURATE neo TAVI procedure. Proof of concept.

Autor: Redondo A; Departamento de Cardiología, Hospital Clínico Universitario, Valladolid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain., Valencia-Serrano F; Departamento de Cardiología, Hospital Torrecárdenas, Almería, Spain., Santos-Martínez S; Departamento de Cardiología, Hospital Clínico Universitario, Valladolid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain., Delgado-Arana JR; Departamento de Cardiología, Hospital Clínico Universitario, Valladolid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain., Barrero A; Departamento de Cardiología, Hospital Clínico Universitario, Valladolid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain., Serrador A; Departamento de Cardiología, Hospital Clínico Universitario, Valladolid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain., Gutiérrez H; Departamento de Cardiología, Hospital Clínico Universitario, Valladolid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain., Sánchez-Lite I; Departamento de Radiología, Hospital Clínico Universitario, Valladolid, Spain., Sevilla T; Departamento de Cardiología, Hospital Clínico Universitario, Valladolid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain., Revilla A; Departamento de Cardiología, Hospital Clínico Universitario, Valladolid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain., Baladrón C; Departamento de Cardiología, Hospital Clínico Universitario, Valladolid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain., Kim WK; Kerckhoff-Klinik GmbH, Herz und Thorax Zentrum, Bad Nauheim, Germany., Carrasco-Moraleja M; Departamento de Cardiología, Hospital Clínico Universitario, Valladolid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain., San Román JA; Departamento de Cardiología, Hospital Clínico Universitario, Valladolid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain., Amat-Santos IJ; Departamento de Cardiología, Hospital Clínico Universitario, Valladolid, Spain. Electronic address: ijamat@gmail.com.
Jazyk: English; Spanish; Castilian
Zdroj: Revista espanola de cardiologia (English ed.) [Rev Esp Cardiol (Engl Ed)] 2022 Mar; Vol. 75 (3), pp. 203-212. Date of Electronic Publication: 2021 Mar 26.
DOI: 10.1016/j.rec.2021.02.004
Abstrakt: Introduction and Objectives: Final position of the neo-commissures is uncontrolled during transcatheter aortic valve implantation (TAVI), potentially hindering coronary access and future procedures. We aimed to develop a standard method to achieve commissural alignment with the ACURATE neo valve.
Methods: The relationship between native and TAVI neo-commissures was analyzed in 11 severe aortic stenosis patients undergoing TAVI. Based on computed tomography analysis, an in silico model was developed to predict final TAVI commissural posts position. A modified implantation technique, accurate commissural alignment (ACA) and a dedicated delivery system were developed. TAVI implants were tested in 3-dimensional (3D) printed models and in vivo. Commissural misalignment and coronary overlap (CO) were analyzed.
Results: The in silico model accurately predicted final position of commissural posts irrespective of the implantation technique performed (correlation coefficient, 0.994; 95%CI, 0.989-0.998; P<.001). TAVI implant with patient-specific rotation was simulated in 3D printed models and in 9 patients. ACA-oriented TAVI implants presented adequate commissural alignment in vivo (mean commissural misalignment of 7.7 ±3.9°). None of the ACA oriented implants showed CO, whereas in silico conventional implants predicted CO in 6 of the 9 cases.
Conclusions: Accurate commissural alignment of the ACURATE neo device is feasible by inserting the delivery system with a patient-specific rotation based on computed tomography analysis. This is a simple and reproducible method for commissural alignment that can be potentially used for all kinds of TAVI devices.
(Copyright © 2021 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.)
Databáze: MEDLINE
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