G Michael Deeb1, Stanley J Chetcuti2, Steven J Yakubov3, Himanshu J Patel4, P Michael Grossman2, Neal S Kleiman5, John Heiser6, William Merhi7, George L Zorn8, Peter N Tadros9, George Petrossian10, Newell Robinson11, Mubashir Mumtaz12, Thomas G Gleason13, Jian Huang14, John V Conte15, Jeffrey J Popma16, Michael J Reardon17. 1. Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan. Electronic address: mdeeb@med.umich.edu. 2. Department of Internal Medicine, Division of Cardiology, University of Michigan, Ann Arbor, Michigan. 3. Department of Cardiology, Riverside Methodist Hospital, Columbus, Ohio. 4. Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan. 5. Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas. 6. Department of Cardiothoracic Surgery, Spectrum Health Hospitals, Grand Rapids, Michigan. 7. Department of Cardiology, Spectrum Health Hospitals, Grand Rapids, Michigan. 8. Department of Cardiothoracic Surgery, University of Kansas Hospital, Kansas City, Kansas. 9. Department of Cardiology, University of Kansas Hospital, Kansas City, Kansas. 10. Department of Cardiology, St. Francis Hospital, Roslyn, New York. 11. Department of Cardiothoracic and Vascular Surgery, St. Francis Hospital, Roslyn, New York. 12. Department of Cardiovascular and Thoracic Surgery, Pinnacle Health, Harrisburg, Pennsylvania. 13. Division of Cardiac Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania. 14. Coronary and Structural Heart Clinical Department, Medtronic, Mounds View, Minnesota. 15. Division of Cardiac Surgery, The Johns Hopkins Hospital, Baltimore, Maryland. 16. Department of Internal Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center, Boston, Massachusetts. 17. Department of Cardiothoracic Surgery, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas.
Abstract
BACKGROUND: This analysis evaluates the relationship of annular size to hemodynamics and the incidence of prosthesis-patient mismatch (PPM) in surgical aortic valve replacement (SAVR) and transcatheter aortic valve replacement (TAVR) patients. METHODS: The CoreValve US Pivotal High Risk Trial, described previously, compared TAVR using a self-expanding valve with SAVR. Multislice computed tomography was used to categorize TAVR and SAVR subjects according to annular perimeter-derived diameter: large (≥26 mm), medium (23 to <26 mm), and small (<23 mm). Hemodynamics, PPM, and clinical outcomes were assessed. RESULTS: At all postprocedure visits, mean gradients were significantly lower for TAVR compared with SAVR in small and medium size annuli (p < 0.001). Annular size was significantly associated with mean gradient after SAVR, with small annuli having the highest gradients (p < 0.05 at all timepoints); gradients were similar across all annular sizes after TAVR. In subjects receiving SAVR, the frequency of PPM was significantly associated with annular size, with small annuli having the greatest incidence. No difference in PPM incidence by annular sizing was observed with TAVR. In addition, TAVR subjects had significantly less PPM than SAVR subjects in small and medium annuli (p < 0.001), with no difference in the incidence of PPM between TAVR and SAVR in large annuli (p = 0.10). CONCLUSIONS: Annular size has a significant effect on hemodynamics and the incidence of PPM in SAVR subjects, not observed in TAVR subjects. With respect to annular size, TAVR results in better hemodynamics and less PPM for annuli less than 26 mm and should be strongly considered when choosing a tissue valve for small and medium size annuli.
BACKGROUND: This analysis evaluates the relationship of annular size to hemodynamics and the incidence of prosthesis-patient mismatch (PPM) in surgical aortic valve replacement (SAVR) and transcatheter aortic valve replacement (TAVR) patients. METHODS: The CoreValve US Pivotal High Risk Trial, described previously, compared TAVR using a self-expanding valve with SAVR. Multislice computed tomography was used to categorize TAVR and SAVR subjects according to annular perimeter-derived diameter: large (≥26 mm), medium (23 to <26 mm), and small (<23 mm). Hemodynamics, PPM, and clinical outcomes were assessed. RESULTS: At all postprocedure visits, mean gradients were significantly lower for TAVR compared with SAVR in small and medium size annuli (p < 0.001). Annular size was significantly associated with mean gradient after SAVR, with small annuli having the highest gradients (p < 0.05 at all timepoints); gradients were similar across all annular sizes after TAVR. In subjects receiving SAVR, the frequency of PPM was significantly associated with annular size, with small annuli having the greatest incidence. No difference in PPM incidence by annular sizing was observed with TAVR. In addition, TAVR subjects had significantly less PPM than SAVR subjects in small and medium annuli (p < 0.001), with no difference in the incidence of PPM between TAVR and SAVR in large annuli (p = 0.10). CONCLUSIONS: Annular size has a significant effect on hemodynamics and the incidence of PPM in SAVR subjects, not observed in TAVR subjects. With respect to annular size, TAVR results in better hemodynamics and less PPM for annuli less than 26 mm and should be strongly considered when choosing a tissue valve for small and medium size annuli.
Authors: Yue Xuan; Danny Dvir; Andrew D Wisneski; Zhongjie Wang; Jian Ye; Julius M Guccione; Liang Ge; Elaine E Tseng Journal: AsiaIntervention Date: 2020-12
Authors: Mauro Chiarito; Alessandro Spirito; Johny Nicolas; Alexandra Selberg; Giulio Stefanini; Antonio Colombo; Bernhard Reimers; Annapoorna Kini; Samin K Sharma; George D Dangas; Roxana Mehran Journal: J Clin Med Date: 2022-07-30 Impact factor: 4.964
Authors: Pier Pasquale Leone; Fabio Fazzari; Francesco Cannata; Jorge Sanz-Sanchez; Antonio Mangieri; Lorenzo Monti; Ottavia Cozzi; Giulio Giuseppe Stefanini; Renato Bragato; Antonio Colombo; Bernhard Reimers; Damiano Regazzoli Journal: Front Cardiovasc Med Date: 2021-06-04