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Choice of Balloon-Expandable Versus Self-Expanding Transcatheter Aortic Valve Impacts Hemodynamics Differently According to Aortic Annular Size.

by Rogers, Toby; Steinvil, Arie; Gai, Jiaxiang; Torguson, Rebecca; Koifman, Edward; Kiramijyan, Starkis; Negi, Smita; Lee, Sang Yeub; Okubagzi, Petros; Satler, Lowell F; Ben-Dor, Itsik; Pichard, Augusto D; Waksman, Ron.
Citation: American Journal of Cardiology. 119(6):900-904, 2017 Mar 15.Journal: The American journal of cardiology.Published: 2017ISSN: 0002-9149.Full author list: Rogers T; Steinvil A; Gai J; Torguson R; Koifman E; Kiramijyan S; Negi S; Lee SY; Okubagzi P; Satler LF; Ben-Dor I; Pichard AD; Waksman R.UI/PMID: 28109558.Subject(s): Aged, 80 and over | Aortic Valve/dg [Diagnostic Imaging] | Aortic Valve/su [Surgery] | Aortic Valve Stenosis/dg [Diagnostic Imaging] | Aortic Valve Stenosis/mo [Mortality] | *Aortic Valve Stenosis/su [Surgery] | Computed Tomography Angiography | Contrast Media | Echocardiography, Doppler | Female | Hemodynamics | Hospital Mortality | Humans | Male | Postoperative Complications/ep [Epidemiology] | *Transcatheter Aortic Valve Replacement/is [Instrumentation] | Transcatheter Aortic Valve Replacement/mo [Mortality] | Treatment Outcome | Washington/ep [Epidemiology]=520 \\ We sought to determine whether balloon-expandable valve (BEV) and self-expanding valve (SEV) affect valve hemodynamics differently according to native aortic annulus size. Transcatheter aortic valve replacement can achieve superior prosthetic valve hemodynamics compared with surgical aortic valve replacement, particularly in patients with small aortic annulus. One hundred ninety-three consecutive transcatheter aortic valve replacement patients were grouped into tertiles defined by computed tomography derived aortic annulus systolic perimeter. The predischarge echocardiogram was analyzed for prosthetic valve hemodynamics. Tertile perimeter cutoffs were 73 and 80 mm. STS score decreased as annulus size increased (7.8% vs 7.6% vs 6.0%, p <0.05 for small, medium, and large annulus, respectively). In patients with small aortic annulus, SEV was associated with significantly higher dimensionless index (0.64 vs 0.53, p = 0.02) and lower peak velocity (1.8 vs 2.4 m/sec, p <0.001) and a trend toward lower mean gradient (7.5 vs 10.0 mm Hg, p = 0.07) compared with BEV. These differences were attenuated and absent in patients with medium and large annulus, respectively. Few patients had moderate/severe paravalvular leak, with no association with valve type or annulus size. There was no difference in mortality between tertiles or valve type at 30 days or 1 year. There was no association between aortic annulus perimeter and 1-year mortality by univariate analysis (hazard ratio 1.00, 95% CI 0.95 to 1.05, p = 0.86) or multivariate analysis (hazard ratio 1.02, 95% CI 0.95 to 1.09, p = 0.60). In conclusion, SEV hemodynamics was superior to BEV in patients with small aortic annulus. This difference was diminished in patients with larger aortic annulus. This study highlights the importance of valve selection in patients with small aortic annulusInstitution(s): MedStar Heart & Vascular InstituteActivity type: Journal Article.Medline article type(s): Journal ArticleOnline resources: Click here to access online Digital Object Identifier: https://dx.doi.org/10.1016/j.amjcard.2016.11.044 (Click here) Abbreviated citation: Am J Cardiol. 119(6):900-904, 2017 Mar 15.Local Holdings: Available online from MWHC library: 1995 - present, Available in print through MWHC library: 1999 - 2006.Abstract: Copyright � 2016 Elsevier Inc. All rights reserved.

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