Aortic root dimensions among patients with severe aortic stenosis undergoing transcatheter aortic valve replacement
| Autor: | Lutz Buellesfeld, Bindu Kalesan, Valentina Delfine, Steffen Gloekler, Peter Wenaweser, Ahmed A. Khattab, Christoph Huber, Fabian Nietlispach, Stefan Stortecky, Stephan Windecker, Bernhard Meier, Balthasar Eberle |
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| Rok vydání: | 2013 |
| Předmět: |
Male
Cardiac Catheterization medicine.medical_treatment 030204 cardiovascular system & hematology Severity of Illness Index Electrocardiography 0302 clinical medicine Valve replacement aortic annulus Prospective Studies 030212 general & internal medicine Cardiac skeleton Prospective cohort study 610 Medicine & health Aged 80 and over Heart Valve Prosthesis Implantation medicine.diagnostic_test Treatment Outcome Aortic Valve Heart Valve Prosthesis Aortic valve stenosis Cardiology cardiovascular system transcatheter aortic valve replacement Female Cardiology and Cardiovascular Medicine medicine.medical_specialty Aortography ascending aorta Cardiac-Gated Imaging Techniques Prosthesis Design 03 medical and health sciences Sex Factors Predictive Value of Tests medicine.artery Internal medicine Multidetector Computed Tomography Ascending aorta medicine Humans Aged Retrospective Studies Chi-Square Distribution business.industry Patient Selection Aortic Valve Stenosis Sinus of Valsalva medicine.disease Surgery Stenosis Linear Models business left ventricular outflow tract |
| Zdroj: | JACC. Cardiovascular interventions |
| DOI: | 10.1016/j.jcin.2012.09.007 |
| Popis: | ObjectivesThe aim of this study was to characterize aortic root dimensions of patients with aortic valve stenosis undergoing transcatheter aortic valve replacement (TAVR) and to evaluate sex differences.BackgroundThe advent of TAVR makes a precise delineation of the aortic root anatomy mandatory and requires a profound anatomic understanding.MethodsPatients planned to undergo TAVR underwent screening imaging with use of a 64-slice or dual-source electrocardiogram-gated contrast-enhanced computed tomography. Anatomic dimensions were assessed at the level of the left ventricular outflow tract (LVOT), annulus, sinus of Valsalva, and ascending aorta.ResultsThe study population comprised 80 men and 97 women (age: 82 ± 6 years) with symptomatic severe aortic valve stenosis. Multislice computed tomography aortic root assessment revealed larger annular and LVOT dimensions in men than women (area annulus: 483.1 ± 75.6 mm2 vs. 386.9 ± 58.5 mm2, p = 0.0002; area LVOT: 478.2 ± 131.0 mm2 vs. 374.0 ± 94.2 mm2, p = 0.0024), whereas dimensions of the ascending aorta were comparable. Both LVOT and annulus were predominantly oval without sex differences, with a higher mean ellipticity index for the LVOT compared with the annulus (1.49 ± 0.2 vs. 1.29 ± 0.1); the ascending aorta was primarily circular (1.07 ± 0.1). Although similar in mean surface area, an area mismatch of annulus and LVOT of more than 10%, 20%, and 40% was detected in 42, 9, and 2 patients, respectively. The mean distance from annulus to the left coronary ostium was smaller than the mean distance of the right coronary ostium (14.4 ± 3.6 mm vs. 16.7 ± 3.6 mm), and distances were lower among women than men.ConclusionsThe aortic root has specific anatomic characteristics, which affect device design, selection, and clinical outcome in patients undergoing TAVR. Female sex is associated with smaller annular and LVOT but not aortic dimensions. The degree of ellipticity as well as a significant mismatch between annular and LVOT dimensions in selected patients deserve careful evaluation. |
| Databáze: | OpenAIRE |
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