1. Effect of ascending aortic dimension on acute procedural success following self-expanding transcatheter aortic valve replacement
- Author
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Hsien-Li Kao, Hideyuki Kawashima, Michael Kang-Yin Lee, Wen Cheng, Rahul Sharma, Tanya Rami, Mamoo Nakamura, Yoshio Maeno, Mohammad Kashif, Tarun Chakravarty, Raj Makkar, Yigal Abramowitz, Yoshio Kazuno, Hasan Jilaihawi, Sharjeel Israr, Geeteshwar Mangat, Jason Chan, Hiroyuki Kawamori, Mao-Shin Lin, Sung-Han Yoon, Masaki Miyasaka, Yusuke Watanabe, and Ken Kozuma
- Subjects
medicine.medical_specialty ,Aorta ,business.industry ,medicine.medical_treatment ,Area under the curve ,Stent ,Retrospective cohort study ,Odds ratio ,030204 cardiovascular system & hematology ,medicine.disease ,Surgery ,03 medical and health sciences ,0302 clinical medicine ,Valve replacement ,Aortic valve stenosis ,medicine.artery ,medicine ,030212 general & internal medicine ,Cardiology and Cardiovascular Medicine ,business ,Cohort study - Abstract
Aims Self–expanding (SE) valves are characterized with long stent frame design and the radial force of the device exists both in the inflow and outflow level. Therefore, we hypothesized that device success of SE-valves may be influenced by ascending aortic dimensions (AAD). The aim of this study was to determine the influence of AAD on acute device success rates following SE transcatheter aortic valve replacement (TAVR). Methods & Results In 4 centers in the United States and Asia, 214 consecutive patients underwent SE-TAVR. Outcomes were assessed in line with Valve Academic Research Consortium criteria. AAD was defined as the sum of the short and long axis aortic diameter divided by 2. Overall, device success rate was 85.0%. Multivariate analysis revealed that increased AAD (Odds ratio 1.27) and % oversizing (Odds ratio 0.88) were found to be independent predictors of unsuccessful device implantation. The c-statistic of the model for device success was area under the curve 0.79, sensitivity 81.3% and specificity 44.0%. Co-existence of several risk factors was associated with an exponential fall to 64.2% in device success rate. For a large AAD, however, optimally oversized SE-valves (threshold 16.2%) resulted with high device success rates compared to suboptimal oversizing (88.6% vs. 64.2%, p=0.005). Conclusions Larger AAD and smaller degrees of oversizing were confirmed to be the most relevant predictors of unsuccessful device implantation following SE-valve implantations. Optimal oversizing of great significance was noted, particularly that with a large AAD.
- Published
- 2017