Impact of Aortic Root Anatomy and Geometry on Paravalvular Leak in Transcatheter Aortic Valve Replacement With Extremely Large Annuli Using the Edwards SAPIEN 3 Valve.

MedStar author(s):
Citation: Jacc: Cardiovascular Interventions. 11(14):1377-1387, 2018 Jul 23.PMID: 29960755Institution: MedStar Heart & Vascular InstituteForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: IN PROCESS -- NOT YET INDEXEDYear: 2018Local holdings: Available online through MWHC library: 2008 - presentISSN:
  • 1936-8798
Name of journal: JACC. Cardiovascular interventionsAbstract: BACKGROUND: The largest recommended annular area for the 29-mm S3 is 683 mm<sup>2</sup>. However, experience with S3 TAVR in annuli >683 mm<sup>2</sup> has not been widely reported.CONCLUSIONS: TAVR with the 29-mm S3 valve beyond the recommended range by overexpansion is safe, with acceptable PVL and pacemaker rates. Larger LVOTs and more eccentric annuli were associated with more PVL. Longer term follow-up will be needed to determine durability of S3 TAVR in this population.Copyright (c) 2018 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.METHODS: From December 2013 to July 2017, 74 patients across 16 centers with mean area 721 +/- 38 mm<sup>2</sup> (range: 684 to 852 mm<sup>2</sup>) underwent S3 TAVR. The transfemoral approach was used in 95%, and 39% were under conscious sedation. Patient, anatomic, and procedural characteristics were retrospectively analyzed. Valve Academic Research Consortium-2 outcomes were reported.OBJECTIVES: The aim of this study was to determine factors affecting paravalvular leak (PVL) in transcatheter aortic valve replacement (TAVR) with the Edwards SAPIEN 3 (S3) valve in extremely large annuli.RESULTS: Procedural success was 100%, with 2 deaths, 1 stroke, and 2 major vascular complications at 30 days. Post-dilatation occurred in 32%, with final balloon overfilling (1 to 5 ml extra) in 70% of patients. Implantation depth averaged 22.3 +/- 12.4% at the noncoronary cusp and 20.7 +/- 9.9% at the left coronary cusp. New left bundle branch block occurred in 17%, and 6.3% required new permanent pacemakers. Thirty-day echocardiography showed mild PVL in 22.3%, 6.9% moderate, and none severe. There was no annular rupture or coronary obstruction. Mild or greater PVL was associated with larger maximum annular and left ventricular outflow tract (LVOT) diameters, larger LVOT area and perimeter, LVOT area greater than annular area, and higher annular eccentricity.All authors: Abramowitz Y, Ahmad H, Amoroso N, Anwaruddin S, Attinger-Toller A, Babaliaros V, Basra SS, Desai ND, Don CW, Gafoor S, George I, Herrmann HC, Hirji SA, Htun NM, Jagasia D, Jilaihawi H, Kamioka N, Kaneko T, Kapadia SR, Kaple R, Khalique OK, Kini AS, Kodali SK, Kozina JA, Krishnaswamy A, Leon MB, Mack MJ, Maeno Y, Makkar RR, Mathur M, Mick SL, Rodes-Cabau J, Salemi A, Shah P, Sharma K, Sharma R, Szerlip MA, Tan CW, Tang GHL, Thourani VH, Webb JG, Wong SC, Zaid S, Zhang MFiscal year: FY2019Digital Object Identifier: Date added to catalog: 2018-07-30
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Journal Article MedStar Authors Catalog Article 29960755 Available 29960755

Available online through MWHC library: 2008 - present

BACKGROUND: The largest recommended annular area for the 29-mm S3 is 683 mm<sup>2</sup>. However, experience with S3 TAVR in annuli >683 mm<sup>2</sup> has not been widely reported.

CONCLUSIONS: TAVR with the 29-mm S3 valve beyond the recommended range by overexpansion is safe, with acceptable PVL and pacemaker rates. Larger LVOTs and more eccentric annuli were associated with more PVL. Longer term follow-up will be needed to determine durability of S3 TAVR in this population.

Copyright (c) 2018 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

METHODS: From December 2013 to July 2017, 74 patients across 16 centers with mean area 721 +/- 38 mm<sup>2</sup> (range: 684 to 852 mm<sup>2</sup>) underwent S3 TAVR. The transfemoral approach was used in 95%, and 39% were under conscious sedation. Patient, anatomic, and procedural characteristics were retrospectively analyzed. Valve Academic Research Consortium-2 outcomes were reported.

OBJECTIVES: The aim of this study was to determine factors affecting paravalvular leak (PVL) in transcatheter aortic valve replacement (TAVR) with the Edwards SAPIEN 3 (S3) valve in extremely large annuli.

RESULTS: Procedural success was 100%, with 2 deaths, 1 stroke, and 2 major vascular complications at 30 days. Post-dilatation occurred in 32%, with final balloon overfilling (1 to 5 ml extra) in 70% of patients. Implantation depth averaged 22.3 +/- 12.4% at the noncoronary cusp and 20.7 +/- 9.9% at the left coronary cusp. New left bundle branch block occurred in 17%, and 6.3% required new permanent pacemakers. Thirty-day echocardiography showed mild PVL in 22.3%, 6.9% moderate, and none severe. There was no annular rupture or coronary obstruction. Mild or greater PVL was associated with larger maximum annular and left ventricular outflow tract (LVOT) diameters, larger LVOT area and perimeter, LVOT area greater than annular area, and higher annular eccentricity.

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