Tian-Yuan Xiong1, Yan-Biao Liao1, Yi-Jian Li1, Fei Chen1, Yuanweixiang Ou1, Xi Wang1, Zi-Jie Wang1, Xi Li1, Zhen-Gang Zhao1, Wei Meng2, Yuan Feng1, Mao Chen3. 1. Department of Cardiology, West China Hospital, Sichuan University, #37 Guo Xue Alley, 610041, Chengdu, China. 2. Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, China. 3. Department of Cardiology, West China Hospital, Sichuan University, #37 Guo Xue Alley, 610041, Chengdu, China. hmaochen@vip.sina.com.
Abstract
BACKGROUND: Some patients referred for transcatheter aortic valve replacement (TAVR) have excessively large annuli (ELA) without device options according to current sizing charts. This retrospective study aims to summarize the presentation and outcomes of ELA patients receiving first-generation self-expanding valves. METHODS: The TAVR database was reviewed in search for cases of self-expanding valves. Patients who had annuli exceeding the perimeter limit on the device sizing chart were referred to as the ELA group. Patients who had annuli within the range covered by the two largest sizes and received the corresponding valve size served as the control group (CG). Baseline, procedures, outcomes, and imaging characteristics on multislice computed tomography (MSCT), such as native anatomy and postimplant stent geometry, were compared. RESULTS: A total of 28 patients were included in the ELA group and 82 in the CG. The patients in the ELA group were younger than those in the CG (72.5 ± 6.2 vs. 75.4 ± 5.8 years, P = 0.03). The median intended perimeter oversizing in relation to the annulus in the ELA group was much smaller than in the CG (-0.4 [-4.6, 4.1] % vs. 16.1 [11.7, 20.8] %, P < 0.01). The calcium burden in the aortic root was around 1.3-fold greater in the ELA group than the CG (756.0 [534.5, 1670.9] vs. 582.1 [310.3, 870.9] mm3, P = 0.01). The need for second valve implantation was higher in ELA (21.4% vs. 12.2%, P = 0.23) but no valve embolization was encountered. The 1‑year follow-up was comparable, including >mild paravalvular leak. CONCLUSION: Under cautious patient selection using MSCT, TAVR with self-expanding valves in patients with ELA appears feasible. Supra-annular structures likely provide the extra anchoring.
BACKGROUND: Some patients referred for transcatheter aortic valve replacement (TAVR) have excessively large annuli (ELA) without device options according to current sizing charts. This retrospective study aims to summarize the presentation and outcomes of ELA patients receiving first-generation self-expanding valves. METHODS: The TAVR database was reviewed in search for cases of self-expanding valves. Patients who had annuli exceeding the perimeter limit on the device sizing chart were referred to as the ELA group. Patients who had annuli within the range covered by the two largest sizes and received the corresponding valve size served as the control group (CG). Baseline, procedures, outcomes, and imaging characteristics on multislice computed tomography (MSCT), such as native anatomy and postimplant stent geometry, were compared. RESULTS: A total of 28 patients were included in the ELA group and 82 in the CG. The patients in the ELA group were younger than those in the CG (72.5 ± 6.2 vs. 75.4 ± 5.8 years, P = 0.03). The median intended perimeter oversizing in relation to the annulus in the ELA group was much smaller than in the CG (-0.4 [-4.6, 4.1] % vs. 16.1 [11.7, 20.8] %, P < 0.01). The calcium burden in the aortic root was around 1.3-fold greater in the ELA group than the CG (756.0 [534.5, 1670.9] vs. 582.1 [310.3, 870.9] mm3, P = 0.01). The need for second valve implantation was higher in ELA (21.4% vs. 12.2%, P = 0.23) but no valve embolization was encountered. The 1‑year follow-up was comparable, including >mild paravalvular leak. CONCLUSION: Under cautious patient selection using MSCT, TAVR with self-expanding valves in patients with ELA appears feasible. Supra-annular structures likely provide the extra anchoring.
Authors: Carl J Schultz; Annick Weustink; Nicolo Piazza; Amber Otten; Nico Mollet; Gabriel Krestin; Robert J van Geuns; Pim de Feyter; Patrick W J Serruys; Peter de Jaegere Journal: J Am Coll Cardiol Date: 2009-09-01 Impact factor: 24.094
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Authors: Darren Mylotte; Thierry Lefevre; Lars Søndergaard; Yusuke Watanabe; Thomas Modine; Danny Dvir; Johan Bosmans; Didier Tchetche; Ran Kornowski; Jan-Malte Sinning; Pascal Thériault-Lauzier; Crochan J O'Sullivan; Marco Barbanti; Nicolas Debry; Jean Buithieu; Pablo Codner; Magdalena Dorfmeister; Giuseppe Martucci; Georg Nickenig; Peter Wenaweser; Corrado Tamburino; Eberhard Grube; John G Webb; Stephan Windecker; Ruediger Lange; Nicolo Piazza Journal: J Am Coll Cardiol Date: 2014-12-01 Impact factor: 24.094