Universität zu Köln

Mauri, Victor, Kim, Won K., Abumayyaleh, Mohammad, Walther, Thomas, Moellmann, Helge, Schaefer, Ulrich, Conradi, Lenard, Hengstenberg, Christian, Hilker, Michael, Wahlers, Thorsten, Baldus, Stephan, Rudolph, Volker, Madershahian, Navid and Rudolph, Tanja K. (2017). Short-Term Outcome and Hemodynamic Performance of Next-Generation Self-Expanding Versus BalloonExpandable Transcatheter Aortic Valves in Patients With Small Aortic Annulus A Multicenter Propensity-Matched Comparison. Circ.-Cardiovasc. Interv., 10 (10). PHILADELPHIA: LIPPINCOTT WILLIAMS & WILKINS. ISSN 1941-7632

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Abstract

Background-Surgical aortic valve replacement in patients with small annular dimensions is challenging because they are at increased risk for prosthesis-patient mismatch and impaired outcomes. Transcatheter aortic valve replacement might be a good alternative; however, comparative data on different transcatheter heart valves are missing. Methods and Results-This multicenter, propensity score-matched study compared hemodynamics and early clinical outcomes in 246 patients with an aortic annulus area <400 mm(2) undergoing transcatheter aortic valve replacement with either a self-expanding transcatheter heart valve (Symetis ACURATE neo, n=129) or a balloon-expandable transcatheter heart valve (Edwards SAPIEN 3, n=117). The 1: 1 propensity score matching resulted in 92 matched pairs. For ACURATE neo versus SAPIEN 3-treated patients, 30-day mortality (0.0% versus 1.0%), 1-year mortality (8.3% versus 13.3%), incidence of stroke (3.3% versus 2.2%), life-threatening bleeding (1.1% versus 1.1%), and major vascular complications (2.2% versus 6.5%), as well as pacemaker implantation rate (12.0% versus 15.2%), were similar. Paravalvular regurgitation >= moderate was rare in both groups (4.5% versus 3.6%). The ACURATE neo presented lower mean transvalvular gradients (9.3 versus 14.5 mm Hg; P<0.001), larger indexed effective orifice areas (0.96 versus 0.80 cm(2)/m(2); P=0.003), and lower rates of severe prosthesis-patient mismatch (3% versus 22%; P=0.004). Hemodynamics were sustained at 1-year follow-up. Conclusions-Albeit a similar safety profile with low clinical event rates, transcatheter aortic valve replacement with the ACURATE neo valve resulted in lower transvalvular gradients and consequently less prosthesis-patient mismatch compared with the SAPIEN 3 in patients with small annulus. These results emphasize the need of careful prosthesis selection in each individual patient.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Mauri, Victor UNSPECIFIED UNSPECIFIED UNSPECIFIED Kim, Won K. UNSPECIFIED UNSPECIFIED UNSPECIFIED Abumayyaleh, Mohammad UNSPECIFIED UNSPECIFIED UNSPECIFIED Walther, Thomas UNSPECIFIED UNSPECIFIED UNSPECIFIED Moellmann, Helge UNSPECIFIED UNSPECIFIED UNSPECIFIED Schaefer, Ulrich UNSPECIFIED UNSPECIFIED UNSPECIFIED Conradi, Lenard UNSPECIFIED UNSPECIFIED UNSPECIFIED Hengstenberg, Christian UNSPECIFIED UNSPECIFIED UNSPECIFIED Hilker, Michael UNSPECIFIED UNSPECIFIED UNSPECIFIED Wahlers, Thorsten UNSPECIFIED UNSPECIFIED UNSPECIFIED Baldus, Stephan UNSPECIFIED UNSPECIFIED UNSPECIFIED Rudolph, Volker UNSPECIFIED UNSPECIFIED UNSPECIFIED Madershahian, Navid UNSPECIFIED UNSPECIFIED UNSPECIFIED Rudolph, Tanja K. UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-215266
DOI:	10.1161/CIRCINTERVENTIONS.117.005013
Journal or Publication Title:	Circ.-Cardiovasc. Interv.
Volume:	10
Number:	10
Date:	2017
Publisher:	LIPPINCOTT WILLIAMS & WILKINS
Place of Publication:	PHILADELPHIA
ISSN:	1941-7632
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language HIGH-RISK PATIENTS; EDWARDS SAPIEN XT; REPLACEMENT; PROSTHESIS; MISMATCH; STENOSIS; IMPLANTATION; DURABILITY; PREDICTORS; TRIAL Multiple languages Cardiac & Cardiovascular Systems Multiple languages
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/21526