Barbara E. Stähli1, Thi Dan Linh Nguyen-Kim3, Cathérine Gebhard1, Ladina Erhart1, Thomas Frauenfelder3, Felix C. Tanner1, Volkmar Falk2, Ulf Landmesser1, Fabian Nietlispach1, Thomas F. Lüscher1, Willibald Maier1, Ronald K. Binder1
University Heart Center, 1Department of Cardiology and 2Department of Cardiovascular Surgery, 3Institute of Diagnostic and Interventional Radiology, University Hospital Zürich, Switzerland
Background and aim of the study: The study aim was to investigate prosthesis-specific predictors for paravalvular aortic regurgitation (PAR) in self-expandable versus balloon-expandable transcatheter heart valves (THVs). PAR is frequently observed after transcatheter aortic valve replacement (TAVR). As self-expandable and balloon-expandable THVs engage differently with the native aortic valve structures, factors that impact PAR may differ between the prosthesis types.
Methods: A total of 137 TAVR patients who underwent pre-procedural multi-detector computed tomography and post-procedural transthoracic echocardiography were studied. Predictors for PAR, including annulus area oversizing and aortic valve calcification mass and volume, were analyzed in a multivariate model.
Results: The Medtronic CoreValve (MCV) prosthesis was utilized in 68 patients (50%), and the Edwards SAPIEN (ES) prosthesis in 69 (50%).
More than mild PAR was observed in 43 patients (32%). Among MCV patients, aortic valve calcification volume and mass were higher in those with more than mild PAR than in those with none or mild PAR (p = 0.04, p = 0.03, respectively). Among ES patients, the annulus area and perimeter oversizing were lower in those with more than mild PAR compared to those with no or mild PAR (p = 0.001). By univariate and multivariate logistic regression analysis, aortic valve calcification mass was the only independent predictor for PAR in MCV patients (p = 0.02), whereas in ES patients it was THV undersizing (p = 0.002), irrespective of the calcific burden.
Conclusion: For self-expandable THVs, aortic valve calcification mass was the strongest predictor of PAR, whereas for balloon-expandable THVs it was prosthesis undersizing. Hence, in patients evaluated for TAVR these parameters should guide the selection of prosthesis type.
The Journal of Heart Valve Disease 2014;23:683-687
|Prosthesis-Specific Predictors of Paravalvular Regurgitation after Transcatheter Aortic Valve Replacement: Impact of Calcification and Sizing on Balloon-Expandable versus Self-Expandable Transcatheter Heart Valves|
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