Faculty of Medicine
Library of the School of Health Sciences

2024-09-06

2024

Bei Evangelia

Εμμανουήλ Βαβουρανάκης, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Δημήτριος Τούσουλης, Ομότιμος Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Χριστόδουλος Στεφανάδης, Ομότιμος Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Κωνσταντίνος Τσιούφης, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Κωνσταντίνα Αγγέλη, Καθηγήτρια, Ιατρική Σχολή, ΕΚΠΑ
Ελευθέριος Τσιάμης, Αναπληρωτής Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Ιγνάτιος Οικονομίδης, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ

Μελέτη των παραμέτρων που επηρεάζουν την τελική θέση της αυτοεκπτυσσόμενης βιοπροσθετικής αορτικής βαλβίδας σε σχέση με την υπάρχουσα ανατομία-μορφολογία. Επίπτωση στη λειτουργικότητα

Greek

Study of the parameters that affect the final implantation depth of self-expandable bioprosthetic aortic valve in relation to the existing anatomy-morphology. Impact on functionality

The displacement (jump) of the bioprosthetic valve (random displacement) during the final stage of its release from the delivery system, following pigtail removal and bioprosthesis’ contact with the left coronary cusp (which is not under operator’s control), seems to be affected by the anatomical and morphological characteristics of the adjacent structures, such as left ventricle, interventricular septal thickness, aortic annulus and ascending aorta.
The aim of this study was to detect the anatomical and morphological differences between patients in whom the implantation depth of the bioprosthetic aortic valve during the final stage was not followed by displacement (Group 1: implantation was not followed by displacement and implantation depth was measured at 4-8mm from the level of the aortic annulus in all coronary cusps) and those whose high displacement was observed during the final phase of bioprosthesis expansion (Group 2: implantation was followed by displacement and implantation depth was <4mm, from the level of the aortic annulus, at least in one coronary cusp).
A total of 120 patients, aged 80.49±7.22 years old, 57 men (47.5%) with symptomatic severe aortic stenosis who underwent transcatheter aortic valve implantation (TAVI) with Medtronic CoreValveTM system were analyzed (Group 1: 65 patients and Group 2: 55, respectively). Patients’ demographic, anatomical and morphological characteristics did not differ significantly between the 2 groups, apart from the past medical history of arterial hypertension (Group 1: 87.7% vs Group 2: 72.7%, p= 0.038) and chronic obstructive pulmonary disease (Group 1: 43.1% vs Group 2: 16.4%, p= 0.002). Balloon predilatation was performed in 45% of the patients (Group 1: 47.7% vs Group 2: 43.6%, p= 0.657). Device success was 95% (Group 1: 92.3% vs Group 2: 98.2%, p= 0.141). The displacement of bioprosthesis towards the non-coronary cusp was greater in Group 2 (A: 1.28±0.93mm vs B: 3.12±1.94mm, p <0.001). Myocardial injury was significantly lower in Group 2, in all measurements. Moreover, conduction disturbances rates, as well as need for permanent pacemaker implantation after TAVI were lower in Group 2, however without statistically significant difference. No significant differences were observed between the 2 groups regarding bioprosthesis functionality immediately after TAVI and during follow-up at 1 and 6 months.
After further analysis of the possible parameters that may affect the final implantation depth, we found that medical history of arterial hypertension and chronic obstructive pulmonary disease play an important role, as well as the evolution of bioprosthesis’ design, which significantly affected also the occurrence of conduction disturbances.

Health Sciences

Aortic valve stenosis, Transcatheter aortic valve implantation, Self-expandable bioprosthetic aortic valve, Implantation depth

No

0

Yes

329

231

File access is restricted until 2026-09-06.

https://pergamos.lib.uoa.gr/uoa/dl/object/3414817