Author + information
- Toby Rogers1,
- Arie Steinvil2,
- Edward Koifman2,
- Sarkis Kiramijyan2,
- Smita Negi2,
- Sang Yeub Lee2,
- Rebecca Torguson2,
- Augusto D. Pichard2,
- Lowell F. Satler2,
- Itsik Ben-Dor2 and
- Ron Waksman2
Aortic annulus size can impact surgical prosthetic valve hemodynamics. The impact of annulus size on hemodynamics and clinical outcomes in patients undergoing transcatheter aortic valve replacement (TAVR) with balloon-expandable (BEV) vs. self-expanding valves (SEV) is not known.
193 consecutive patients from a single center undergoing TAVR with a BEV or SEV were categorized into tertiles according to contrast-enhanced CT-derived aortic annulus perimeter (small annulus (SAA) <73mm, medium ≥73mm and <80mm, large (LAA) ≥80mm). Baseline characteristics, valve hemodynamics by echocardiography and clinical outcomes were compared.
Patients with SAA were more likely to be female (87.4 vs. 16.2%, p<0.001, SAA vs. LAA) and had lower body surface area (1.7 vs. 2.0m2, p<0.001, SAA vs. LAA). Dimensionless index was higher (0.64 vs. 0.53; P=0.02) and peak velocity was lower (1.8 vs. 2.4m/sec, p<0.001) for SEV vs. BEV in patients with SAA, but there was no difference in patients with LAA. There was a trend towards more paravalvular leak with SEV in SAA, but only mild-moderate in severity. Annulus size did not impact mortality at 1 year (11.1 vs. 13.0%, p=0.94, SAA vs. LAA).
In patients with aortic stenosis undergoing TAVR, annulus size does not impact outcomes. Valve hemodynamics are more favorable with SEV than with BEV in patients with SAA. This can be attributed to the supra-annular location of the valve leaflets and may influence valve type selection in patients with SAA.
|n=193||Small aortic annulus||Medium aortic annulus||Large aortic annulus|
|BEV (n=32)||SEV (n=30)||p value||BEV (n=36)||SEV (n=27)||p value||BEV (n=39)||SEV (n=29)||p value|
|Mean aortic valve gradient (mmHg)||10.0±1.4||7.5±1.4||0.07||16.0±8.5||6.2±1.4||0.35||10.4±5.3||9.0±2.4||0.55|
|Peak aortic valve velocity (m/sec)||2.4±0.4||1.8±0.4||<0.001||2.3±0.4||1.8±0.4||<0.001||2.1±0.4||2.0±0.3||0.40|
|Moderate||8 (42.1)||4 (23.5)||0.17||14 (50.0)||5 (29.4)||0.22||15 (46.9)||1- (52.6)||0.77|
|Severe||0 (0.0)||0 (0.0)||—||0 (0.0)||0 (0.0)||—||0 (0.0)||0 (0.0)||—|
|Moderate/Severe||0 (0.0)||5 (20.8)||0.05||3 (9.1)||1 (3.8)||0.44||2 (6.1)||2 (8.3)||1.00|