Universität zu Köln

Eghbalzadeh, Kaveh, Rahmanian, Parwis Baradaran, Giese, Daniel, Kuhn, Elmar W., Djordjevic, Ilija ORCID: 0000-0002-5810-8626, Kaya, Suereyya, Weber, Carolyn, Baldus, Stephan, Mader, Navid and Wahlers, Thorsten C. W. (2020). SAVR versus TAVI: What about the Hemodynamic Performance? An In Vivo and In Vitro Analysis. Thorac. Cardiovasc. Surg., 68 (7). S. 608 - 616. STUTTGART: GEORG THIEME VERLAG KG. ISSN 1439-1902

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Abstract

Background Surgical aortic valve replacement (SAVR) is nowadays discussed whether it remains the gold standard of treatment. In the last decade, there has been a tremendous increase in transcatheter aortic valve implantation (TAVI) due to the growing expertise and excellent results of the catheter-based approach. We, therefore, retrospectively compared the rapid deployment valve (RDV), the Edwards Intuity valve (IEV), with the Edwards Sapien 3 (S3V) with regard to post-procedural hemodynamics. Methods A total of 246 patients treated with TAVI or SAVR between February 2009 and November 2015 were included. One-hundred twenty-five patients were analyzed in the SAVR group and compared with 121 patients undergoing TAVI. Transvalvular pressure gradients (PGs) and the incidence and extent of aortic regurgitation (AR) were compared post-procedurally by echocardiography for each valve size. In vitro hemodynamics were analyzed by placing both valves into an aortic silicone phantom connected to a pulsatile flow pump and measured using phase-contrast magnetic resonance imaging (4D flow MRI). Results Post-procedurally, mean transvalvular PGs for the 23mm valves were 9 (7;11.5) versus 13 (9;18) ( p <0.001), whereas maximum PGs were 16.5 (14;22) versus 25.5mm Hg (17.5;34) ( p <0.001) in IEV and S3V patients, respectively. The 21mm IEV showed significantly lower transvalvular PGs compared with the 23mm S3V: mean PGs: 11 (8;13) versus 13 (9;18) ( p <0.05); maximum PG: 19.5 (13;24) versus 25.5 (18;34) mm Hg ( p <0.05). Analysis revealed significantly lower post-procedural transvalvular PGs for larger valves sizes. With respect to AR, the incidence of AR was significantly lower in IEV group ( p <0.05). In vitro velocities and turbulent kinetic energy values showed similar results between both valves. Conclusion Implanted RDVs presented a lower incidence of paravalvular regurgitation and were associated with significantly lower post-procedural transvalvular PGs, especially for small valve sizes. Our data might support the application of rapid deployment aortic valves in patients with small aortic annulus in the TAVI era.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Eghbalzadeh, Kaveh UNSPECIFIED UNSPECIFIED UNSPECIFIED Rahmanian, Parwis Baradaran UNSPECIFIED UNSPECIFIED UNSPECIFIED Giese, Daniel UNSPECIFIED UNSPECIFIED UNSPECIFIED Kuhn, Elmar W. UNSPECIFIED UNSPECIFIED UNSPECIFIED Djordjevic, Ilija UNSPECIFIED orcid.org/0000-0002-5810-8626 UNSPECIFIED Kaya, Suereyya UNSPECIFIED UNSPECIFIED UNSPECIFIED Weber, Carolyn UNSPECIFIED UNSPECIFIED UNSPECIFIED Baldus, Stephan UNSPECIFIED UNSPECIFIED UNSPECIFIED Mader, Navid UNSPECIFIED UNSPECIFIED UNSPECIFIED Wahlers, Thorsten C. W. UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-316869
DOI:	10.1055/s-0039-1695779
Journal or Publication Title:	Thorac. Cardiovasc. Surg.
Volume:	68
Number:	7
Page Range:	S. 608 - 616
Date:	2020
Publisher:	GEORG THIEME VERLAG KG
Place of Publication:	STUTTGART
ISSN:	1439-1902
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language AORTIC-VALVE-REPLACEMENT; PERMANENT PACEMAKER IMPLANTATION; RAPID-DEPLOYMENT; HIGH-RISK; PARAVALVULAR REGURGITATION; PATIENT MISMATCH; SAPIEN 3; TRANSCATHETER; SUTURELESS; OUTCOMES Multiple languages Cardiac & Cardiovascular Systems; Respiratory System; Surgery Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/31686