Author + information
- Received February 25, 2019
- Revision received July 2, 2019
- Accepted July 30, 2019
- Published online December 11, 2019.
- Kerstin Piayda, MDa,∗ (, )
- Katharina Hellhammer, MDa,
- Verena Veulemans, MDa,
- Horst Sievert, MDb,c,
- Sameer Gafoor, MDb,d,
- Shazia Afzal, MDa,
- Inga Hennig, BAa,
- Matthias Makosch, BAa,
- Amin Polzin, MDa,
- Christian Jung, MD, PhDa,
- Ralf Westenfeld, MDa,
- Malte Kelm, MDa,e and
- Tobias Zeus, MDa
- aDivision of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- bCardioVascularCenter Frankfurt, Frankfurt, Germany
- cAnglia Ruskin University, Chelmsford, United Kingdom
- dSwedish Heart and Vascular, Seattle, Washington
- eCardiovascular Research Institute Düsseldorf, Düsseldorf, Germany
- ↵∗Address for correspondence:
Dr. Kerstin Piayda, Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University, Medical Faculty, Moorenstraße 5, Düsseldorf 40225, Germany.
Objectives This study sought to predict whether different methods of calculating the implantation depth (ID) influence clinical and hemodynamic outcome reporting in patients undergoing transcatheter aortic valve replacement (TAVR) with a self-expandable device.
Background Different approaches exist to calculate the ID, which may influence uniform and reliable reporting because the updated Valve Academic Research Consortium (VARC-2) criteria do not provide specific instructions.
Methods The clinical and hemodynamic outcomes of 258 patients undergoing TAVR with a third-generation self-expandable device were analyzed with regard to the method used to assess the ID as follows: arithmetic mean, the arithmetic mean of the measured distances from the noncoronary cusp and the left coronary cusp to the distal prosthesis end; noncoronary cusp distance, the distance from the noncoronary cusp to the distal prosthesis end; and deepest edge, the deepest edge of the distal prosthesis end.
Results Regardless of the measurement method, the optimal ID (OID) was reached in <30% (arithmetic mean, 25.4%; noncoronary cusp distance, 28.4%; deepest edge, 20.5%; p = 0.008). The deepest edge method is the most stringent to differentiate the relevant outcome parameters, such as the need for permanent pacemaker implantation (OID 3.7% vs. no OID 14.6%; p = 0.033). The hemodynamic outcome (i.e., mean pressure gradient reduction after TAVR: OID 7.4 ± 3.4 mm Hg vs. no OID 8.3 ± 4.0 mm Hg; p = 0.093) was not affected.
Conclusions The OID was reached in <30% of TAVR procedures. The various methods applied for ID calculation significantly influence the outcome reporting and do not allow a uniform perception of the ID. (Multi Modal Cardiac Imaging Prior Transcatheter Aortic Valve Implantation; NCT01805739)
Dr. Veulemans has received consulting fees, travel expenses, or study honorariums from Medtronic and Edwards Lifesciences outside of this work. Dr. Sievert has received study honoraria, travel expenses, and consulting fees from 4tech Cardio, Abbott, Ablative Solutions, Ancora Heart, Append Medical, Bavaria Medizin Technologie GmbH, Bioventrix, Boston Scientific, Carag, Cardiac Dimensions, Celonova, Comed B.V., Contego, CVRx, Dinova, Edwards, Endologix, Hangzhou Nuomao Medtech, Hemoteq, Holistick Medical, Lifetech, Maquet Getinge Group, Medtronic, Mitralign, Mokita, Nuomao Medtech, Occlutech, pfm Medical, Recor, Renal Guard, Rox Medical, Terumo, Vascular Dynamics, Vectorious Medtech, Venus, and Vivasure Medical outside of this work. Dr. Zeus has received consulting fees, travel expenses, or study honorariums from Medtronic and Edwards Lifesciences outside of this work. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received February 25, 2019.
- Revision received July 2, 2019.
- Accepted July 30, 2019.
- 2019 American College of Cardiology Foundation
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