3D打印技术在评估经股动脉经导管主动脉瓣置换术中冠状动脉阻塞风险有效性的分析

Analysis of the effectiveness of 3D printing technology in predicting the risk of coronary artery obstruction during transcatheter aortic valve replacement through the femoral artery route

目的探究3D打印技术预测经股动脉途径经导管主动脉瓣置换术中冠状动脉阻塞风险的有效性。方法收集2017年9月至2021年11月于郑州市第七人民医院接受经股动脉途径经导管主动脉瓣置换术的患者100例,筛选其中重度狭窄伴或不伴反流的患者45例进行回顾性研究。CT组数据来源于CT血管造影(CTA),3D组数据来源于通过患者术前影像数据进行3D打印技术重建的主动脉根部模型,测量变量包括左右冠状动脉开口高度,瓣叶类型,狭窄程度,钙化程度及分布,主动脉瓣解剖结构(瓣环直径、左室流出道直径、升主动脉直径)(4cm处)等数据,观察两组数据是否存在差异性。结果通过瓣环面积、流出道面积、窦部大小、冠状动脉开口高度等参数进行评估,3D打印与CT测量差异无统计学意义(P>0.05)。3D打印在瓣环长径、瓣环短径、瓣环周长、流出道周长、根部钙化体积、升主直径、窦管交界直径等参数在预测冠状动脉阻塞风险的准确率大于CT测量,差异有统计学意义(P<0.05)。结论3D打印技术预测经股动脉途径经导管主动脉瓣置换术中冠状动脉阻塞风险的有效性较CT更为准确。

Objective To evaluate the effectiveness of 3D printing technology in predicting the risk of coronary artery occlusion during transcatheter aortic valve replacement(TAVR)via femoral artery.Methods Clinical data were collected from 100 patients who had undergone transcatheter aortic valve replacement via femoral artery at the 7th People's Hospital of Zhengzhou from September 2017 to November 2021.For the retrospective analysis,45 patients exhibiting severe stenosis,with or without regurgitation,were selected.Data for the CT group were derived from computed tomography angiography(CTA),whereas the data for the 3D group were sourced from the aortic root models that had been reconstructed using 3D printing technology based on preoperative imaging data.Variables measured included the heights of the left and right coronary orifices,types of valve leaflets,degrees of stenosis,extent and distribution of calcification,and the anatomical structures of the aortic valve,such as the diameters of the valve annulus,the left ventricular outflow tract,and the ascending aorta at 4 cm from the valve.The objective was to ascertain if significant differences existed between the two data sets.Results Assessments were conducted using parameters such as annulus area,outflow tract area,sinus size,and coronary ostium height;no statistically significant differences were observed between the measurements obtained via 3D printing and CT(P>0.05).However,3D printing demonstrated greater accuracy than CT in predicting the risk of coronary artery occlusion based on parameters including the long and short diameters of the annulus,annulus circumference,outflow tract circumference,calcification volume at the root,ascending aorta diameter,and sinus junction diameter,with these differences being statistically significant(P<0.05).Conclusion 3D printing technology offers greater accuracy than CT imaging in predicting the risk of coronary artery occlusion during transcatheter aortic valve replacement via the femoral artery approach.