Author + information
- S1936879815022281-bb7d56defc47dfa50850f194a4d010d0Toby Rogers1,
- S1936879815022281-b41fe52590ef8bb393cebb8b291037bfArie Steinvil2,
- S1936879815022281-0e824b6bd196b6c074117d96f588e1f3Edward Koifman2,
- S1936879815022281-22ca6bb575feb9b0401e73b8ef13bd3aSarkis Kiramijyan2,
- S1936879815022281-05002cb46075934f124e1def1fbd79a4Smita Negi2,
- S1936879815022281-a6c1bc52851ff7a2f92d51d27345d37fSang Yeub Lee2,
- S1936879815022281-43188b297454714a1e633ce32956ff39Rebecca Torguson2,
- S1936879815022281-6a643b5155cb73800c3dcdf29c00727cAugusto D. Pichard2,
- S1936879815022281-1afcf597a9ea0e6a884d08efd238ef1fLowell F. Satler2,
- S1936879815022281-280150bfca3f0be2b424079de79e87c6Itsik Ben-Dor2 and
- S1936879815022281-772b1cb1fca98a9f26e1e7f8bddc725bRon 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|