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Transcatheter aortic valve implantation in patients with a small aortic annulus: performance of supra-, intra- and infra-annular transcatheter heart valves

Authors :
Matthias Renker
Lisa Voigtländer
Won-Keun Kim
Tobias Schmidt
Niklas Schofer
M. Linder
Hermann Reichenspurner
Matti Adam
Georg Nickenig
Dirk Westermann
Victor Mauri
Atsushi Sugiura
Lenard Conradi
Alina Goßling
Jan-Malte Sinning
Moritz Seiffert
Stefan Blankenberg
Christian W. Hamm
Source :
Clinical Research in Cardiology
Publication Year :
2021
Publisher :
Springer Berlin Heidelberg, 2021.

Abstract

Background A small aortic annulus is associated with increased risk of prosthesis–patient mismatch (PPM) after transcatheter aortic valve implantation (TAVI). Whether specific transcatheter heart valve (THV) designs yield superior hemodynamic performance in these small anatomies remains unclear. Methods Data from 8411 consecutive patients treated with TAVI from May 2012 to April 2019 at four German centers were retrospectively evaluated. A small aortic annulus was defined as multidetector computed tomography-derived annulus area 2. TAVI was performed with a balloon-expanding intra-annular (Sapien-3, n = 288), self-expanding intra-annular (Portico, n = 110), self-expanding supra-annular (Evolut, n = 179 and Acurate-Neo, n = 428) and mechanically expanding infra-annular (Lotus, n = 64) THV according to local practice. PPM was defined as indexed effective orifice area ≤ 0.85cm2/m2. Results A small annulus was found in 1069 (12.7%) patients. PPM was detected in 38.3% overall with a higher prevalence after implantation of a balloon-expanding intra-annular or mechanically expanding infra-annular THV compared to self-expanding intra- and supra-annular THV. Multivariable analysis linked self-expanding THV (Evolut: Odds ratio [OR] 0.341, Acurate-Neo: OR 0.436, Portico: OR 0.291), postdilatation (OR 0.648) and age (OR 0.968) to lower rates of PPM, while aortic valve calcification was associated with an increased risk (OR 1.001). Paravalvular regurgitation > mild was more frequent after TAVI with self-expanding THV (p = 0.04). Conclusion In this large contemporary multicenter patient population, a substantial number of patients with a small aortic anatomy were left with PPM after TAVI. Self-expanding supra- and intra-annular THV demonstrated superior hemodynamics in these patients at risk, however at the cost of higher rates of residual paravalvular regurgitation. Graphic abstract

Details

Language :
English
ISSN :
18610692 and 18610684
Volume :
110
Issue :
12
Database :
OpenAIRE
Journal :
Clinical Research in Cardiology
Accession number :
edsair.doi.dedup.....a572e5331e7a8012fda88c5489fa86de