BACKGROUND: The effect of aortic valve replacement on three-dimensional mitral annular geometry has not been well described. Emerging transcatheter approaches for aortic valve replacement employ fundamentally different mechanical techniques for achieving fixation and seal of the prosthetic valve than standard surgical aortic valve replacement. This study compares the immediate impact of transcatheter aortic valve replacement (TAVR) and standard surgical aortic valve replacement (AVR) on mitral annular anatomy. METHODS: Real-time three-dimensional echocardiography was performed in patients undergoing TAVR using the Edwards Sapien valve (n = 10 [Edwards Lifesciences, Irvine, CA]) or AVR (n = 10) for severe aortic stenosis. Mitral annular geometric indexes were measured using Tomtec EchoView (Tomtec Imaging Systems, Munich, Germany) to assess regional and global annular geometry. RESULTS: Mixed between-within analysis of variance showed no differences between TAVR and AVR groups in any of the mitral annular geometric indices preoperatively. However, postoperative analysis did demonstrate an effect of AVR on geometry. Patients undergoing open AVR had significant decrease in annular height, septolateral diameter, mitral valve transverse diameter, and mitral annular area after valve replacement (p ≤ 0.006). Similar changes were not noted in the TAVR group. CONCLUSIONS: Mitral annular geometry is better preserved by TAVR than by AVR. Thus, TAVR may be a more physiologic approach to aortic replacement.
BACKGROUND: The effect of aortic valve replacement on three-dimensional mitral annular geometry has not been well described. Emerging transcatheter approaches for aortic valve replacement employ fundamentally different mechanical techniques for achieving fixation and seal of the prosthetic valve than standard surgical aortic valve replacement. This study compares the immediate impact of transcatheter aortic valve replacement (TAVR) and standard surgical aortic valve replacement (AVR) on mitral annular anatomy. METHODS: Real-time three-dimensional echocardiography was performed in patients undergoing TAVR using the Edwards Sapien valve (n = 10 [Edwards Lifesciences, Irvine, CA]) or AVR (n = 10) for severe aortic stenosis. Mitral annular geometric indexes were measured using Tomtec EchoView (Tomtec Imaging Systems, Munich, Germany) to assess regional and global annular geometry. RESULTS: Mixed between-within analysis of variance showed no differences between TAVR and AVR groups in any of the mitral annular geometric indices preoperatively. However, postoperative analysis did demonstrate an effect of AVR on geometry. Patients undergoing open AVR had significant decrease in annular height, septolateral diameter, mitral valve transverse diameter, and mitral annular area after valve replacement (p ≤ 0.006). Similar changes were not noted in the TAVR group. CONCLUSIONS: Mitral annular geometry is better preserved by TAVR than by AVR. Thus, TAVR may be a more physiologic approach to aortic replacement.
Authors: Martin B Leon; Craig R Smith; Michael Mack; D Craig Miller; Jeffrey W Moses; Lars G Svensson; E Murat Tuzcu; John G Webb; Gregory P Fontana; Raj R Makkar; David L Brown; Peter C Block; Robert A Guyton; Augusto D Pichard; Joseph E Bavaria; Howard C Herrmann; Pamela S Douglas; John L Petersen; Jodi J Akin; William N Anderson; Duolao Wang; Stuart Pocock Journal: N Engl J Med Date: 2010-09-22 Impact factor: 91.245
Authors: John G Webb; Sanjeevan Pasupati; Karin Humphries; Christopher Thompson; Lukas Altwegg; Robert Moss; Ajay Sinhal; Ronald G Carere; Brad Munt; Donald Ricci; Jian Ye; Anson Cheung; Sam V Lichtenstein Journal: Circulation Date: 2007-07-23 Impact factor: 29.690
Authors: Morten Ø Jensen; Henrik Jensen; Sten L Nielsen; Morten Smerup; Peter Johansen; Ajit P Yoganathan; Hans Nygaard; J Michael Hasenkam Journal: J Heart Valve Dis Date: 2008-05
Authors: Marc Ruel; Varun Kapila; Joel Price; Alexander Kulik; Ian G Burwash; Thierry G Mesana Journal: Circulation Date: 2006-07-04 Impact factor: 29.690
Authors: Ivan S Salgo; Joseph H Gorman; Robert C Gorman; Benjamin M Jackson; Frank W Bowen; Theodore Plappert; Martin G St John Sutton; L Henry Edmunds Journal: Circulation Date: 2002-08-06 Impact factor: 29.690
Authors: Morten O Jensen; Henrik Jensen; Morten Smerup; Robert A Levine; Ajit P Yoganathan; Hans Nygaard; J Michael Hasenkam; Sten L Nielsen Journal: Circulation Date: 2008-09-30 Impact factor: 29.690