Transcatheter aortic valve implantation in patients with a small aortic annulus: performance of supra-, intra- and infra-annular transcatheter heart valves
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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. / Voigtländer, Lisa; Kim, Won-Keun; Mauri, Victor; Goßling, Alina; Renker, Matthias; Sugiura, Atsushi; Linder, Matthias; Schmidt, Tobias; Schofer, Niklas; Westermann, Dirk; Reichenspurner, Hermann; Nickenig, Georg; Blankenberg, Stefan; Hamm, Christian; Conradi, Lenard; Adam, Matti; Sinning, Jan-Malte; Seiffert, Moritz.
In: CLIN RES CARDIOL, Vol. 110, No. 12, 12.2021, p. 1957-1966.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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T1 - Transcatheter aortic valve implantation in patients with a small aortic annulus: performance of supra-, intra- and infra-annular transcatheter heart valves
AU - Voigtländer, Lisa
AU - Kim, Won-Keun
AU - Mauri, Victor
AU - Goßling, Alina
AU - Renker, Matthias
AU - Sugiura, Atsushi
AU - Linder, Matthias
AU - Schmidt, Tobias
AU - Schofer, Niklas
AU - Westermann, Dirk
AU - Reichenspurner, Hermann
AU - Nickenig, Georg
AU - Blankenberg, Stefan
AU - Hamm, Christian
AU - Conradi, Lenard
AU - Adam, Matti
AU - Sinning, Jan-Malte
AU - Seiffert, Moritz
N1 - © 2021. The Author(s).
PY - 2021/12
Y1 - 2021/12
N2 - 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 < 400 mm2. 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.
AB - 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 < 400 mm2. 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.
KW - Aged
KW - Aged, 80 and over
KW - Aortic Valve/diagnostic imaging
KW - Aortic Valve Stenosis/diagnosis
KW - Calcinosis/diagnosis
KW - Female
KW - Fluoroscopy
KW - Heart Valve Prosthesis
KW - Humans
KW - Male
KW - Multidetector Computed Tomography
KW - Prosthesis Design
KW - Retrospective Studies
KW - Transcatheter Aortic Valve Replacement/methods
KW - Treatment Outcome
U2 - 10.1007/s00392-021-01918-8
DO - 10.1007/s00392-021-01918-8
M3 - SCORING: Journal article
C2 - 34387736
VL - 110
SP - 1957
EP - 1966
JO - CLIN RES CARDIOL
JF - CLIN RES CARDIOL
SN - 1861-0684
IS - 12
ER -
