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• W2095396227 abstract "BackgroundThe aim of this study was to analyze the angle between the left ventricular (LV) long axis and the LV outflow tract (αLV-LVOT) on cardiac computed tomography and to describe its effect on the occurrence of paravalvular leakage (PL), fluoroscopy time, and postoperative creatine kinase-MB levels in transapical transcatheter aortic valve replacement (TA-TAVR).MethodsHigh-risk patients with severe aortic stenosis scheduled for TA-TAVR using an Edwards SAPIEN (Edwards Lifesciences, Irvine, CA) prosthesis were retrospectively included. The αLV-LVOT was measured during systole and diastole as far as retrospectively gated data sets were available. The αLV-LVOT was correlated with the occurrence of PL, total fluoroscopy time, and postoperative creatine kinase-MB levels. Interobserver variability was assessed in all cases.ResultsThe study included 81 patients (57 women [70.4%], 24 men [29.6%]) with an average age of 81.9 ± 5.8 years. The mean αLV-LVOTs were 61.8 ± 9.9 degrees during systole and 61.1 ± 10.0 degrees during diastole. There was a minimal, nonsignificant change in the αLV-LVOT between systole and diastole of 0.2 ± 4.1 degrees (p = 0.7). PL was found in 39 patients: grade 0 in 42 (51.9%), grade I in 30 (37.0%), and grade II in 9 (11.1%). Patients with a clinically significant PL (grade ≥ II) showed a significantly greater mean αLV-LVOT than patients with grade I or without PL (mean difference, 13.8 ± 3.2 degrees; p < 0.001). No significant correlation was found between the αLV-LVOT and total fluoroscopy time (r = –0.17, p = 0.16) and postoperative creatine kinase-MB levels (r = –0.1, p = 0.44).ConclusionsDuring TA-TAVR, greater αLV-LVOTs were associated with significantly higher grades of PL. Thus, the αLV-LVOT might influence the selection of the transapical implantation path and could have a significant effect on designs for future stents or novel delivery devices. The aim of this study was to analyze the angle between the left ventricular (LV) long axis and the LV outflow tract (αLV-LVOT) on cardiac computed tomography and to describe its effect on the occurrence of paravalvular leakage (PL), fluoroscopy time, and postoperative creatine kinase-MB levels in transapical transcatheter aortic valve replacement (TA-TAVR). High-risk patients with severe aortic stenosis scheduled for TA-TAVR using an Edwards SAPIEN (Edwards Lifesciences, Irvine, CA) prosthesis were retrospectively included. The αLV-LVOT was measured during systole and diastole as far as retrospectively gated data sets were available. The αLV-LVOT was correlated with the occurrence of PL, total fluoroscopy time, and postoperative creatine kinase-MB levels. Interobserver variability was assessed in all cases. The study included 81 patients (57 women [70.4%], 24 men [29.6%]) with an average age of 81.9 ± 5.8 years. The mean αLV-LVOTs were 61.8 ± 9.9 degrees during systole and 61.1 ± 10.0 degrees during diastole. There was a minimal, nonsignificant change in the αLV-LVOT between systole and diastole of 0.2 ± 4.1 degrees (p = 0.7). PL was found in 39 patients: grade 0 in 42 (51.9%), grade I in 30 (37.0%), and grade II in 9 (11.1%). Patients with a clinically significant PL (grade ≥ II) showed a significantly greater mean αLV-LVOT than patients with grade I or without PL (mean difference, 13.8 ± 3.2 degrees; p < 0.001). No significant correlation was found between the αLV-LVOT and total fluoroscopy time (r = –0.17, p = 0.16) and postoperative creatine kinase-MB levels (r = –0.1, p = 0.44). During TA-TAVR, greater αLV-LVOTs were associated with significantly higher grades of PL. Thus, the αLV-LVOT might influence the selection of the transapical implantation path and could have a significant effect on designs for future stents or novel delivery devices." @default.
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• W2095396227 date "2014-11-01" @default.
• W2095396227 modified "2023-10-03" @default.
• W2095396227 title "Access Path Angle in Transapical Aortic Valve Replacement: Risk Factor for Paravalvular Leakage" @default.
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• W2095396227 doi "https://doi.org/10.1016/j.athoracsur.2014.06.055" @default.
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