CT TAVI Planning技术在经导管主动脉置换术前的预测性研究

Predictive study of CT transcatheter aortic valve implantation planning technology before transcatheter aortic replacement

目的:探讨使用飞利浦CT TAVI Planning软件对主动脉瓣膜狭窄的患者在经导管主动脉置换术(TAVI)围手术期的术前指导价值,对主动脉进行综合测量评估,根据测量结果对TAVI瓣膜支架的型号进行预测性研究,并与术中经食道超声测量结果对比分析。方法:回顾性研究,搜集我院2017年1月至2019年6月经临床诊断严重主动脉瓣病变,并具有外科治疗的高危因素和手术禁忌证,最终行TAVI手术的患者32例,男性18例,女性14例,年龄68~84岁,平均年龄(70.82±6.07)岁,使用TAVI Planning软件测量主动脉瓣环、主动脉窦、窦管交界、主动脉瓣环下5 mm左心室流出道、窦管交界上方4 cm升主动脉、冠状动脉开口、主动脉窦高度及最佳投影角度,根据测量结果对患者手术瓣膜支架型号进行预测分析,计算CT预测准确率;根据经食道超声测量结果,计算超声预测准确率。结果:CT TAVI Planning软件测量主动脉瓣环直径大于经食道超声瓣环直径,CT预测准确率为87.5%,经食道超声预测准确率56.3%,将两者准确率使用卡方检验进行比较分析,差异有统计学意义(P均<0.05)。将CT和超声测量主动脉瓣环直径建立ROC曲线,CT敏感度及特异度均高于经食道超声。结论:使用CT TAVI Planning软件进行主动脉CTA检查要优于经食道超声检查,可以为TAVI手术提供重要的参考价值。

Objective:To explore the use of Philips CT TAVI Planning software to comprehensively measure and evaluate the aorta of patients with aortic valve stenosis during transcatheter aortic valve implantation(TAVI)perioperative period,to conduct predictive research on the type of TAVI valve stent according to the measurement result,and to compare and analyze the measurement result with transesophageal ultrasound during operation.Methods:A retrospective study was conducted to collect 32 patients male 18,female 14,age:68-84 years old,average age(70.82±6.07)who underwent TAVI after clinical diagnosis of severe aortic valve disease from January 2017 to June 2019 and had high risk factors and contraindications for surgical treatment.TAVI Planning software was used to measure aortic annulus,aortic sinus,sinus junction,5 mm left ventricular outflow tract under aortic annulus,4 cm ascending aorta above sinus junction,coronary artery opening,aortic sinus height and optimal projection angle.According to the measurement result,the model of surgical valve stent for patients was predicted and analyzed,and CT prediction accuracy was calculated.According to the transesophageal ultrasound measurement result,the accuracy of ultrasound prediction is calculated.Results:The diameter of aortic annulus measured by CT TAVI Planning software is larger than that of transesophageal echocardiography.The accuracy of CT prediction is 87.5%and that of transesophageal echocardiography is 56.3%.The accuracy of CT and transesophageal echocardiography was compared and analyzed by Chi-square test,P<0.05,and the difference was statistically significant.ROC curve was established by measuring aortic annulus diameter with CT and ultrasound.The sensitivity and specificity of CT were higher than those of transesophageal ultrasound.Conclusions:CT TAVI Planning software is superior to transesophageal ultrasonography in aortic CTA examination,which can provide important reference value for TAVI operation.