Optimal Balloon Size in Balloon Aortic Valvuloplasty : Results from a Retrospective Analysis of Multi-slice Computed Tomography

Optimal Balloon Size in Balloon Aortic

Valvuloplasty: Results from a Retrospective

Analysis of Multi-slice Computed Tomography

:Multi-slice Computed

Tomography

1

2

2

3

5

11

13

13

14

BAV

2D

TTE

CT

TTE

CT

acute gain

BAV

MSCT

BAV

MSCT

22

CT

area-derived aortic annulus diameter

AREAd , aortic annulus minimum diameter MINd

2D

TTE

(TTEd)

B

1)B/AREAd =Maximum balloon size/ CT Area-derived aortic annulus

diameter

2)B/MINd =Maximum balloon size/

CT aortic annulus minimum

diameter

3)B/TTEd =Maximum balloon size/(TTE annulus diameter)

Doppler

velocity index(DVI)

DVI/

DVI

1.3

B/AREAd

(p=0.16)

DVI

B/AREAd>0.936

AREAd 0.936

DVI

B/AREAd>0.936

DVI

(p=0.06) B/AREAd>0.936

DVI

AR

MSCT

(B/AREAd>0.936)

Balloon aortic valvuloplasty BAV aortic stenosis AS [1]

[1,2] TAVI BAV

transcatheter aortic valve implantation TAVI AS

2D transthoracic echocardiography TTE

BAV TTE

[2,3] acute gain 2D TTE

aortic regurgitation AR AR

2D TTE aortic valve area AVA

TAVI Multi-slice Computed

Tomography MSCT AVA

2D TTE CT

[4] CT BAV

MSCT area-derived aortic annulus diameter ( AREAd

) BAV

MSCT AREAd

2012 12 2017 3 AS BAV 75 75 MSCT AREAd BAV procedure BAV Proglide pre-close 25 14Fr 8Fr 135 (Mullins introducer set) 2 25 4Fr 10 gooseneck

catheter pigtail catheter 6Fr Swan-Ganz

catheter 8Fr 135 (Mullins

introducer set) 6Fr wedge-balloon catheter

Gorlin

0.032 spring-tip guidewire 6Fr

wedge-balloon catheter

0.032 extra-stiff wire 6Fr wedge-balloon catheter

gooseneck catheter wedge-balloon catheter 8Fr

135 (Mullins introducer set) extra-stiff wire 2D TTE 5mms ( 5 ) AR TTE AR BAV [5,6]

ASE ESE BAV

AS

Effective orifice area EOA

0.25

AS [7] BAV

acute gain ratio

2D TTE [8]

TTE TTEd

( B ) B/TTEd BAV

AR AR jet

I, II, III IV BAV [9]

MSCT

CT AREAd aortic annulus minimum diameter ( MINd) aortic annulus maximum diameter 3 Mensio Structural Heart [10,11]

MSCT 3 annular plane

AREAd MINd aortic annulus maximum diameter

AREAd (B)

B/AREAd MINd (B) B/AREAd

JMP Student t t DVI/ DVI 1.3 B/AREAd ROC p<0.05

BAV 75 BAV 66 BAV 9 MSCT 24 EOA 2 22 BAV 75 BAV 66 BAV 9 BAV 66 MSCT 24 24 TTE EOA 2 22 ( 1) 1 1

BAV: MSCT: Multi-slice computed tomography EOA: effective orifice area 1 Ê¿® ¿¾´» Ó»¿² o ÍÜ ±® Ò«³¾»® øû÷ Number of patients 22 Age, years 85 ± 5 Male sex 7 (32)

Body surface area, m2 _{1.42 ± 0.17}

Diabetes mellitus 7 (32)

Dyslipidemia 8 (36)

Chronic kidney disease 8 (36)

NYHA grade I 4 (18) II 14 (64) III 1 (5) IV 3 (14) EuroSCORE II 4.9 (4.0 - 5.4) STS PROM 7.0 ± 2.9

Left ventricular diastolic dimension, mm 45.9 ± 5.9 Left ventricular ejection fraction, % 59.2 ± 13.3 Peak transaortic valve velocity, m/s 5.0 ± 0.8 Transaortic mean pressure gradient, mmHg 54.0 (46.8 - 73.5) Effective orifice area, cm2 _{0.55 ± 0.11}

Doppler velocity index 0.20 ± 0.06

Aortic annulus diameter, mm 20.5 ± 1.5 Pre-procedural AR None 1 (5) I 13 (59) II 8 (36) III 0 (0) IV 0 (0)

NYHA: New York Heart Association AR: aortic regurgitation

BAV EOA DVI [EOA

(cm2_{) 0.55 ± 0.11 vs. 0.80 ± 0.20, p<0.001; DVI 0.20 ± 0.06 vs. 0.27 ± 0.12, p<0.001; pre-}

vs. post-]

2 EOA DVI

EOA DVI (R=0.46, p=0.03) EOA

2 BAV EOA DVI

EOA: Effective orifice area DVI: Doppler velocity index

DVI>0.25 DVI

DVI/ DVI

1.3 2 DVI/ DVI>1.3

DVI/ DVI 1.3

2 B/AREAd B/MINd B/TTEd 3

B/MINd B/TTEd B/AREAd (0.92 ± 0.04 vs 0.89 ± 0.05, p=0.16) B/AREAd DVI 1.3 ROC B/AREAd>0.936 (AUC 0.684 p=0.20 0.54 0.89 3) B/AREAd×0.936 3 B/AREAd 0.936

2 B/AREAd B/MINd B/TTEd

°óª¿´«»

B/AREAd 0.92 ± 0.04 0.89 ± 0.05 0.1608

B/MINd 1.06 ± 0.10 1.04 ± 0.07 0.6201

B/TTEd 1.01 ± 0.06 1.02 ± 0.08 0.7322

B/AREAd =(Maximum balloon size)/ (CT Area-derived aortic annulus diameter B/MINd =(Maximum balloon size)/ (CT aortic annulus minimum diameter B/TTEd =(Maximum balloon size)/ (TTE annulus diameter)

3 B/AREAd ( DVI/ DVI>1.3) ROC

3 B/AREAd>0.936 B/AREAd 0.936

Ê¿® ¿¾´» ÞñßÎÛß¼âðòçíê ÞñßÎÛß¼ ðòçíê °óª¿´«»

Number of patients 8 14

Age, years 83 ± 2 85 ± 1 0.37

Male sex, n (%) 6 (75) 9 (64) 0.60

Body surface area, m2 _{1.40 ± 0.06 1.44 ± 0.05 0.62}

Hypertension, n (%) 7 (88) 11 (79) 0.60

Diabetes mellitus, n (%) 3 (38) 4 (29) 0.67

Dyslipidemia, n (%) 5 (63) 3 (21) 0.05

Chronic kidney disease, n (%) 4 (50) 4 (29) 0.31

NYHA grade, n (%) 0.82 I 2 (25) 2 (14) II 5 (63) 9 (64) III 0 (0) 1 (7) IV 1 (13) 2 (14) EuroSCORE II 5.0 (3.5 - 6.5) 4.8 (4.1 - 5.4) 0.97 STS PROM 8.2 ± 1.0 6.3 ± 0.7 0.15 LVDd, mm 45.8 ± 2.1 46.0 ± 1.6 0.93 LVEF, % 61.3 ± 4.8 58.0 ± 3.6 0.58

Peak transaortic valve velocity, m/s 5.2 (4.3 5.5) 4.7 (4.5 - 5.4) 0.71 Transaortic mean PG, mmHg 53.5 (44.5 74.5) 54.0 (46.8 - 73.5) 1.00 Effective orifice area, cm2 _{0.53 ± 0.04 0.55 ± 0.03 0.66}

Doppler velocity index 0.22 ± 0.02 0.18 ± 0.02 0.16

Aortic annulus diameter, mm 21.1 ± 0.5 20.1 ± 0.4 0.14

Pre-procedural AR, n (%) 0.74 None 0 (0) 1 (7) I 5 (63) 8 (57) II 3 (38) 5 (36) III 0 (0) 0 (0) IV 0 (0) 0 (0)

NYHA: New York Heart Association AR: aortic regurgitation (B/AREAd 0.936) 14 6 (43%) 6 BAV AR 2 (33%) (B/AREAd>0.936) 8 7 (88%) 7 BAV AR 2 (28%) ( 4) (B/AREAd>0.936) (B/AREAd 0.936) AR (p=0.85) DVI

(B/AREAd>0.936) (B/AREAd 0.936) DVI

(0.33 ± 0.17 vs. 0.24 ± 0.06, p=0.06)

(B/AREAd>0.936) (B/AREAd 0.936)

(88% vs 43%, p=0.04)

1)BAV EOA DVI

2) EOA DVI 3)DVI

( DVI/ DVI>1.3) B/AREAd>0.936

4)B/AREAd>0.936 AR

DVI

BAV 50mmHg

40 50% [2]

TAVI BAV BAV

AR Bail-out TAVI TAVI TAVI TAVI BAV 2D TTE BAV BAV EOA 0.23 2 _{DVI 0.06}

Narrative review[2] TAVI EOA 0.30

(0.28-0.40) TAVI 0.34 (0.21-0.43) TAVI EOA

(>0.30 cm2_{) (<0.30 cm}2₎

BAV

BAV EOA

TAVI TAVI BAV

TAVI EOA

TAVI

MSCT area-derived aortic annulus diameter AREAd B/AREAd>0.936

B/AREAd>0.936 8 7 (88%) BAV AR

DVI 5 1

B/AREAd>0.936 DVI

43mmHg 19mmHg 35% 40% DVI

EOA

AR B/AREAd>0.936

BAV TAVI TAVI

5 B/AREAd B/TTEd

clinical outcome

conventional balloon BAV

B/AREAd

MSCT area-derived aortic annulus diameter AREAd B/AREAd>0.936

9.

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The Bulletin of the Yamaguchi Medical School Vol.65 No.3-No.4 Optimal Balloon Size in Balloon Aortic Valvuloplasty: Results from a Retrospective Analysis of Multi-slice Computed Tomography