Matti Adam1, Victor Mauri2, Sarah Schmidt2, Vera Fortmeier3, Sebastian Ludwig4, Hendrik Wienemann2, Maria Isabel Körber2, Samuel Lee2, Max Meertens2, Sascha Macherey2, Christos Iliadis2, Elmar Kuhn5, Kaveh Eghbalzadeh5, Sabine Bleiziffer6, Stephan Baldus2, Niklas Schofer4, Tanja Katharina Rudolph3. 1. Department of Cardiology, Heart Center, Faculty of Medicine, University of Cologne, Matti Adam Kerpener Str. 62, 50937, Cologne, Germany. matti.adam@uk-koeln.de. 2. Department of Cardiology, Heart Center, Faculty of Medicine, University of Cologne, Matti Adam Kerpener Str. 62, 50937, Cologne, Germany. 3. General and Interventional Cardiology, Heart and Diabetes Centre NRW, Bad Oeynhausen, Ruhr University Bochum, Bochum, Germany. 4. Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany. 5. Department of Cardiothoracic Surgery, Heart Centre, Faculty of Medicine, University of Cologne, Cologne, Germany. 6. Department of Cardiothoracic Surgery, Heart and Diabetes Centre NRW, Bad Oeynhausen, Ruhr University Bochum, Bochum, Germany.
Abstract
OBJECTIVES: This study aimed to compare hemodynamic characteristics of different self-expanding (SE) and balloon-expandable (BE) transcatheter heart valves (THV) in relation to native aortic annulus anatomy. BACKGROUND: A patient centered THV selection becomes increasingly important as indications for transcatheter aortic valve replacement (TAVR) are extended towards lower risk populations. METHODS: Hemodynamic parameters including mean gradient (MG), effective orifice area (EOA), Doppler velocity index (DVI), degree of paravalvular regurgitation (PVR) and patient-prosthesis mismatch (PPM) were compared by valve type, label size and in relation to quintiles of native aortic annulus area. RESULTS: 2609 patients were treated at 3 centers in Germany with SAPIEN 3 (n = 1146), ACURATE Neo (n = 649), Evolut R (n = 546) or Evolut Pro (n = 268) THV. SE THVs provided superior hemodynamics in terms of larger EOA, higher DVI and lower MG compared to BE THV, especially in patients with small aortic annuli. Severe PPM was less frequent in SE treated patients. The rate of PVR ≥ moderate was comparable for SE and BE devices in smaller annular dimensions, but remarkably lower for BE TAVR in large aortic annular dimensions (> 547.64 mm2) (2% BE THV vs. > 10% for SE THV; p < 0.001). CONCLUSIONS: Patients with small aortic annular dimensions may benefit hemodynamically from SE THV. With increasing annulus size, BE THV may have advantages since PVR ≥ moderate occurs less frequently.
OBJECTIVES: This study aimed to compare hemodynamic characteristics of different self-expanding (SE) and balloon-expandable (BE) transcatheter heart valves (THV) in relation to native aortic annulus anatomy. BACKGROUND: A patient centered THV selection becomes increasingly important as indications for transcatheter aortic valve replacement (TAVR) are extended towards lower risk populations. METHODS: Hemodynamic parameters including mean gradient (MG), effective orifice area (EOA), Doppler velocity index (DVI), degree of paravalvular regurgitation (PVR) and patient-prosthesis mismatch (PPM) were compared by valve type, label size and in relation to quintiles of native aortic annulus area. RESULTS: 2609 patients were treated at 3 centers in Germany with SAPIEN 3 (n = 1146), ACURATE Neo (n = 649), Evolut R (n = 546) or Evolut Pro (n = 268) THV. SE THVs provided superior hemodynamics in terms of larger EOA, higher DVI and lower MG compared to BE THV, especially in patients with small aortic annuli. Severe PPM was less frequent in SE treated patients. The rate of PVR ≥ moderate was comparable for SE and BE devices in smaller annular dimensions, but remarkably lower for BE TAVR in large aortic annular dimensions (> 547.64 mm2) (2% BE THV vs. > 10% for SE THV; p < 0.001). CONCLUSIONS: Patients with small aortic annular dimensions may benefit hemodynamically from SE THV. With increasing annulus size, BE THV may have advantages since PVR ≥ moderate occurs less frequently.
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