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The design and flow profile of transcatheter aortic valve (TAVI) is different from surgical prosthetic valve. We compared the post implantation echocardiographic aortic valve gradient of patients undergoing TAVI using Edwards Sapien in our institution to that of surgically implanted bioprosthetic valves (SAVR) using St Jude Epic, Hancock and Mitrflow valves during the same period.
Consecutive patients who underwent TAVI between January 2010 and May 2011 were included. Patients who underwent SAVR for native aortic stenosis (AS) were identified from our database and patients who completed at least one follow up transthoracic echocardiogram (TTE) were included for final analysis. The last performed TTE was included for analysis in both groups.
Thirty six patients underwent TAVI valves between January 2010 and May 2011 and TTE data were available for 34 patients who were included for final analysis. Seventy two patients underwent SAVR with a bioprosthetic valve during the same period and TTE data were available for 30 patients who were included for final analysis. Mean age (TAVI 83.4 ± 5.8 vs SAVR 76.3 ± 5.2 years, p <0.001) and logistic Euroscore (TAVI 26.4 ± 12.5 vs SAVR 8.4 ± 5.2, p <0.001) were significantly higher in the TAVI group but the body surface area an important determinant of echo gradient was similar in both groups (TAVI 1.8 ± 0.23 vs SAVR 1.83 ± 0.24, p=0.34). The pre procedure peak aortic valve gradients (TAVI 85.2 ± 20.1 vs SAVR 83.0 ± 22.3, p=0.67) were similar in both groups but the mean aortic valve gradients (TAVI 53.2 ± 14.46 vs SAVR 45.8 ± 12.8, p <0.05) were significantly higher in the TAVI group. The post implant peak gradients (TAVI 21.09 ± 11.5 vs SAVR 30.24 ± 10.6, p <0.005) and mean gradients (TAVI 12.66 ± 7.9 vs SAVR 17.03 ± 6.7, p <0.05) were significantly lower in the TAVI group. Incidence of LV dysfunction was similar in both groups (TAVI 8 vs SAVR 6, p=0.77) but there was an increase incidence of mild to moderate aortic regurgitation in the TAVI group (TAVI 22 vs SAVR 9, p <0.05).
Our initial results suggest excellent early haemodynamic performance of Edwards Sapien TAVI valve compared to the commonly used surgical bio prosthetic valves.