Optimal Angiographic View for Implantation of Self-Expanding Transcatheter Aortic Valves
- Authors: Mardanyan G.V.1, Chargazia S.G.1, Kur-ipa K.A.1, Polyakov R.S.1,2, Puretskiy M.V.2,1, Pirkova A.A.1, Vlasko G.S.1, Popov S.O.1, Abugov S.A.1,2
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Affiliations:
- Russian Research Center of Surgery
- Russian Medical Academy of Continuing Professional Education
- Issue: Vol 78, No 4 (2023)
- Pages: 305-313
- Section: CARDIOLOGY AND CARDIOVASCULAR SURGERY: CURRENT ISSUES
- Published: 01.11.2023
- URL: https://vestnikramn.spr-journal.ru/jour/article/view/12465
- DOI: https://doi.org/10.15690/vramn12465
- ID: 12465
Cite item
Abstract
Background. Transcatheter aortic valve implantation is safe and effective alternative to surgical treatment of severe aortic valve stenosis among patients of all risk groups. Optimal implantation depth is key for successful hemodynamic and clinical
Results. Despite the improvement of prostheses design and increasing experience of operators cardiac conduction abnormalities and paravalvular leak continue to be a significant complication of this procedure, directly affecting the long-term prognosis. Self-expanding valves require special approaches for optimal angiographic projection to assess the implantation depth of the prosthesis.
Aims — in this study we compared coplanar view and cusp overlap technique during self-expanding aortic valves implantation.
Methods. We performed a retrospective analysis of 81 TAVI performed in Russian Research Center of Surgery. The patients were divided into two groups depending on the implantation projection: coplanar view (CV) and cusp overlap technique (COT). The incidence of cardiac conduction abnormalities (cumulative incidence of third degree AV block and left bundle branch block) depending on the implantation projection was analyzed. The procedural characteristics in the form of contrast agent volume, fluoroscopic time and operator comfort were also evaluated.
Results. After TAVI 16 (51.6%) and 13 (26.0%) patients had cardiac conduction disturbances (cumulative incidence of third degree AV block and left bundle branch block) in the CV and COT respectively (p = 0.019). In the CV group, 2 (6.5%) patients, and in the COT group, 3 (6%) patients had third degree AV block (p = 0.935) and 14 (45.2%) и 10 (20%) left bundle branch block (p = 0,016). In the COT group, there was a significant decrease contrast media (181 ± 66.4 mL vs. 158.9 ± 50.8 mL, p = 0.032). Fluoroscopic time also decreased (23.2 ± 7.7 min vs. 21.3 ± 6.8 min), but without a significant difference (p = 0.678). According to the results of the operator survey, the COT projection was more comfortable.
Conclusions. Optimal implantation depth is an important condition for achieving hemodynamic efficiency of the prosthesis and reducing the risk of conduction abnormalities. Operator comfort, better assessment of the implantation depth, safety and efficiency of the cusp overlap technique allow its use as the main implantation view for TAVI.
Full Text
About the authors
Gayk V. Mardanyan
Russian Research Center of Surgery
Author for correspondence.
Email: haikrurg@gmail.com
ORCID iD: 0000-0002-7442-520X
SPIN-code: 2707-0511
MD, PhD
Russian Federation, 2 Abrikosovsky lane, 119991, MoscowShota G. Chargazia
Russian Research Center of Surgery
Email: shota.chg@gmail.com
ORCID iD: 0000-0002-8598-2933
SPIN-code: 5965-6158
Clinical Resident
Russian Federation, 2 Abrikosovsky lane, 119991, MoscowKiazim A. Kur-ipa
Russian Research Center of Surgery
Email: kuripo90@gmail.com
ORCID iD: 0000-0002-2395-5999
SPIN-code: 1778-4140
Clinical Resident
Russian Federation, 2 Abrikosovsky lane, 119991, MoscowRoman S. Polyakov
Russian Research Center of Surgery; Russian Medical Academy of Continuing Professional Education
Email: roman.polyakov@gmail.com
ORCID iD: 0000-0002-9323-4003
SPIN-code: 9515-5680
MD, PhD, Professor
Russian Federation, 2 Abrikosovsky lane, 119991, Moscow; 2/1, building 1, Barrikadnaya st., 123242, MoscowMikhail V. Puretskiy
Russian Medical Academy of Continuing Professional Education; Russian Research Center of Surgery
Email: 9672287797@mail.ru
ORCID iD: 0000-0003-4988-4102
SPIN-code: 8905-1410
MD, PhD, Professor
Russian Federation, 2 Abrikosovsky lane, 119991, Moscow; 2/1, building 1, Barrikadnaya st., 123242, MoscowAleksandra A. Pirkova
Russian Research Center of Surgery
Email: 9672287797@mail.ru
ORCID iD: 0000-0002-5101-1004
SPIN-code: 4024-4326
MD, PhD
Russian Federation, 2 Abrikosovsky lane, 119991, MoscowGordey S. Vlasko
Russian Research Center of Surgery
Email: vlasko13@yandex.ru
ORCID iD: 0000-0001-8521-7126
SPIN-code: 9687-2557
PhD, Student
Russian Federation, 2 Abrikosovsky lane, 119991, MoscowSergey O. Popov
Russian Research Center of Surgery
Email: Dr.Popov_S@mail.ru
ORCID iD: 0000-0002-4488-1597
MD, PhD
Russian Federation, 2 Abrikosovsky lane, 119991, MoscowSergey A. Abugov
Russian Research Center of Surgery; Russian Medical Academy of Continuing Professional Education
Email: sabugov@gmail.com
ORCID iD: 0000-0001-7636-4044
SPIN-code: 1126-8001
MD, PhD, Professor, Corresponding Member of the RAS
Russian Federation, 2 Abrikosovsky lane, 119991, Moscow; 2/1, building 1, Barrikadnaya st., 123242, MoscowReferences
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