| Objective:To investigate the impact of aortic root morphology on the implantation depth of aortic valve prosthesis during trans-catheter aortic valve replacement(TAVR)in bicuspid aortic valve patients.Methods:Clinical data of 40 patients with native bicuspid aortic valve stenosis who underwent TAVR using the self-expandable prosthesis(the Venus A-valve)from 2014 to 2017 in Fuwai hospital was retrospectively analyzed.The patients were divided into non-deep implantation group(implant depth?10 mm by instant angiogram after implantation,29 cases)and deep implantation group(implant depth>10 mm by instant angiogram after implantation,11 cases).Pre-procedural aortic root characteristics(e.g.calcification,angle and dimensions)were assessed by CT.The impact of aortic root morphology on the implantation depth and clinical outcomes were also evaluated.Results:The age was(75.1 ± 5.9)years with equal representation from the raphe-type and non-raphe type(52.5%(21/40)and 47.5%(19/40)).The bigger aorta angle((56.5±4.5)° vs.(47.4±9.4)°t=-3.070,P=0.004),more frequent mild-calcification(HU850,<200 mm3)or severe-calcification(HU850,>1 000 mm3)of aortic leaflets(7/11 vs.4/29,? 2=7.595,P=0.006),as well as higher ratio of left ventricular outflow tract perimeter to annulus perimeter((109.2±7.5)%vs.(101.5 ± 6.5)%,t=-3.097,P=0.004)were found in the deep implantation group compared to the non-deep implantation group.The new in-hospital onset of bundle-branchheart-block or atrioventricularblockconduction disturbance rate was higher in the deep implantation group than in the non-deep implantation group(6/11 vs.2/29,?2=8.534,P=0.030).Left ventricular ejection fraction was similar between deep implantation group and non-deep implantation group at baseline((49.9±8.9)%vs.(55.8±10.4)%,t=-1.609,P=0.117),and was significantly lower in the deep implantation group than in the non-deep implantation group at 30 days after implantation((51.6±12.8)%vs.(60.9±8.1)%,t=2.437,P=0.020).Conclusion:Aortic root morphology of bicuspid aortic valve patients is associated with implantation depth of the prosthesis during TAVR,which affects the conduction system and left ventricular function during and post TAVR.Objectives:This study sought to characterize the computed tomography(CT)imaging results of Venus-A valve prosthesis at 1 year post transcatheter aortic valve replacement(TAVR)due to severe aortic stenosis and explore the impact on hemodynamic and clinical outcomes.Methods:A total of 30 consecutive patients,who underwent TAVR using Venus-A valve from 2012-9 to 2014-12 and finished 1-year CT evaluation,were included in this study.One-year CT data including the eccentricity index,expansion rate at different levels of the prosthesis,the implantation depth and leaflet thickening were retrospectively analyzed.We further assessed their impact on post-procedural hemodynamic and clinical outcomes.Results:The expansion rate(by area)of the Venus-A prosthesis was significantly higher at functional level(B plane)([106.7±17.2])%than that at inflow level(A plane)([84.1±20.6]%,P<0.05)and outflow level(Cplane)[(86.0 ± 15.3)%,P<0.05)].B plane expansion rate([116.9±17.7]%vs[103.6±1.5]%,P=0.132)and the eccentricity index of the sinus level(B'plane)([12.3±4.3]%vs[17.9±8.5]%,P=0.118)were similar between patients with bicuspid and tricuspid aortic valves.Sufficient stent expansion(B plane expansion rate by area ? 100%)were achieved in 23 cases(76.7%).There wasno significant difference in preoperative sinus mean diameter,calcification volume,implantation depth and post balloon dilatation between patients with insufficient expansion(B plane expansion rate<100%by area)and sufficient expansion(P>0.05).The aortic valve maximum velocity at 1 year was significantly higher in insufficient expansion patients than those patients with sufficient expansion([2.6 ± 0.5]m/s vs[2.1±0.4]m/s,P=0.023).There was no significant difference in the prosthesis leaflet thickening,paravalvular leak,left ventricular ejection fraction and improvement of NYHA class at 1-year follow-up between patients with insufficient or sufficient expansion(P>0.05).Conclusions:CT imaging evidenced high frequency of sufficient expansion in Venus-A valve and satisfied hemodynamic outcomes among post-TAVR patients at 1-year post TAVR,which is associated with satisfactory clinical follow-up results.Objective:To evaluate the safety and efficacy of a self-expanding valve(TaurusOne(?)transcatheter aortic valve system)in the treatment of patients with symptomatic severe aortic stenosis in China.Methods:A prospective;multi-center,single arm study was designed to enroll 120 patients with symptomatic severe aortic stenosis receive TAVI using TaurusOne(?) valve.The primary endpoint was all-cause mortality at 1 year.Results:From September 2017 to April 2019,120 patients were enrolled(35%bicuspid aortic valve,mean Society of Thoracic Surgeon(STS)score 9.95%).1-year mortality in 120 patients(follow-up rate,100%),was 6.7%(upper 95%confidence interval:12.9%)which was significantly lower than the performance goal of 30%(P<0.0001).All stroke,myocardial infarction,paravavular leak?moderate,new pacemaker implantation occurred in 4.4%,1.8%,0.8%,and 22.1%at 1-year.The hemodynamic results and quality of life scores also improved significantly.Patients with bicuspid valve had similar outcomes as those with tricuspid aortic valve.Conclusions:The 1-year clinical results confirm the safety and efficacy of the TaurusOne(?)transcatheter aortic valve system in the treatment of patients with symptomatic severe tricuspid and bicuspid aortic stenosis. |
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