Alexis Theron1, Johan Pinto1, Dominique Grisoli1, Karolina Griffiths2, Erwan Salaun3, Nicolas Jaussaud1, Eléonore Ravis1, Marc Lambert3, Lyna Messous1, Cecile Amanatiou1, Thomas Cuisset3, Vlad Gariboldi1, Roch Giorgi2,4,5,6, Gilbert Habib3, Frederic Collart1. 1. Department of Cardiac Surgery, La Timone Hospital, La Timone Hospital 264, rue saint Pierre 13005 Marseille, France. 2. APHM, Hôpital de la Timone, Service Biostatistique et Technologies de l'Information et de la Communication, Marseille, France. 3. Department of Cardiology, La Timone Hospital, Marseille, France. 4. Aix-Marseille Université, UMR_S 912 (SESSTIM), IRD, 13385 Marseille, France. 5. INSERM, UMR_S 912 (SESSTIM), 13385 Marseille, France. 6. Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Marseille, France.
Abstract
Aims: When compared with the former Sapien XT (XT-THV), the Sapien 3 trans-catheter heart valve (S3-THV) embeds an outer annular sealing cuff to prevent para-valvular regurgitation (PVR). The consequences of this new feature on valve haemodynamics have never been evaluated. We aimed to compare both types of prostheses regarding patient-prosthesis mismatch (PPM). Methods and results: Patients who underwent a TAVR for aortic stenosis were retrospectively included. Regression adjustment for the propensity score was used to compare 50 XT-THV patients with 71 S3-THV. At the 1-month follow-up, the mean indexed effective orifice area (iEOA) was 1.12 ± 0.34 cm2/m2 with XT-THV and 0.96 ± 0.27 cm2/m2 with S3-THV. The mean gradient was 11 ± 5 mmHg and 13 ± 5 mmHg, respectively. Nine patients had moderate PPM, and two exhibited severe PPM with XT-THV. Nineteen patients had moderate PPM, and seven demonstrated severe PPM with S3-THV. There was a five-fold increased risk of PPM with S3-THV (OR = 4.98; [1.38-20.94], P = 0.019). S3-THV decreased the iEOA by 0.21 cm2/m2 [-0.21; (-0.38 to - 0.05); P = 0.012] and increased the mean gradient by 4.95 mmHg [4.95; (2.27-7.64); P < 0.001]. The risk of PPM was increased 15.24-fold with 23 mm S3-THV [15.24; (2.92-101.52); P = 0.002] in comparison with the 23 mm XT-THV. PVR were reduced by 98% with S3-THV. Conclusion: There is an increased risk of PPM with 23mm S3-THV in comparison with 23 mm XT-THV. This may be attributable to the additional sub-annular cuff that avoids the risk of PVR. Regarding the increased vulnerability of younger patients to PPM, we provide essential information on the extension of TAVR indication to the younger population. Published on behalf of the European Society of Cardiology. All rights reserved.
Aims: When compared with the former Sapien XT (XT-THV), the Sapien 3 trans-catheter heart valve (S3-THV) embeds an outer annular sealing cuff to prevent para-valvular regurgitation (PVR). The consequences of this new feature on valve haemodynamics have never been evaluated. We aimed to compare both types of prostheses regarding patient-prosthesis mismatch (PPM). Methods and results: Patients who underwent a TAVR for aortic stenosis were retrospectively included. Regression adjustment for the propensity score was used to compare 50 XT-THVpatients with 71 S3-THV. At the 1-month follow-up, the mean indexed effective orifice area (iEOA) was 1.12 ± 0.34 cm2/m2 with XT-THV and 0.96 ± 0.27 cm2/m2 with S3-THV. The mean gradient was 11 ± 5 mmHg and 13 ± 5 mmHg, respectively. Nine patients had moderate PPM, and two exhibited severe PPM with XT-THV. Nineteen patients had moderate PPM, and seven demonstrated severe PPM with S3-THV. There was a five-fold increased risk of PPM with S3-THV (OR = 4.98; [1.38-20.94], P = 0.019). S3-THV decreased the iEOA by 0.21 cm2/m2 [-0.21; (-0.38 to - 0.05); P = 0.012] and increased the mean gradient by 4.95 mmHg [4.95; (2.27-7.64); P < 0.001]. The risk of PPM was increased 15.24-fold with 23 mm S3-THV [15.24; (2.92-101.52); P = 0.002] in comparison with the 23 mm XT-THV. PVR were reduced by 98% with S3-THV. Conclusion: There is an increased risk of PPM with 23mm S3-THV in comparison with 23 mm XT-THV. This may be attributable to the additional sub-annular cuff that avoids the risk of PVR. Regarding the increased vulnerability of younger patients to PPM, we provide essential information on the extension of TAVR indication to the younger population. Published on behalf of the European Society of Cardiology. All rights reserved.
Authors: Jerome Ferrara; Alexis Theron; Alizee Porto; Pierre Morera; Paul Luporsi; Nicolas Jaussaud; Vlad Gariboldi; Frederic Collart; Thomas Cuisset; Pierre Deharo Journal: J Clin Med Date: 2022-04-01 Impact factor: 4.241
Authors: Maria Estefania Otto; Fernando Antibas Atik; Marcelo do Nascimento Moreira; Luiz Carlos Madruga Ribeiro; Bianca Corrêa Rocha de Mello; Joyce Gomes Elias Lima; Maiara Sanchez Ribeiro; Ana Carolina Pereira Matos Domingues; Reyna Pinheiro Calzada; Armindo Jreige; Larissa Lucas Schloicka; Philippe Pibarot Journal: Arq Bras Cardiol Date: 2020-01 Impact factor: 2.000