Universität zu Köln

Voigtlaender, Lisa, Kim, Won-Keun, Mauri, Victor, Gossling, Alina, Renker, Matthias, Sugiura, Atsushi, Linder, Matthias, Schmidt, Tobias, Schofer, Niklas, Westermann, Dirk, Reichenspurner, Hermann, Nickenig, Georg, Blankenberg, Stefan, Hamm, Christian, Conradi, Lenard, Adam, Matti, Sinning, Jan-Malte and Seiffert, Moritz (2021). Transcatheter aortic valve implantation in patients with a small aortic annulus: performance of supra-, intra- and infra-annular transcatheter heart valves. Clin. Res. Cardiol., 110 (12). S. 1957 - 1967. HEIDELBERG: SPRINGER HEIDELBERG. ISSN 1861-0692

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Abstract

Background A small aortic annulus is associated with increased risk of prosthesis-patient mismatch (PPM) after transcatheter aortic valve implantation (TAVI). Whether specific transcatheter heart valve (THV) designs yield superior hemodynamic performance in these small anatomies remains unclear. Methods Data from 8411 consecutive patients treated with TAVI from May 2012 to April 2019 at four German centers were retrospectively evaluated. A small aortic annulus was defined as multidetector computed tomography-derived annulus area < 400 mm(2). TAVI was performed with a balloon-expanding intra-annular (Sapien-3, n = 288), self-expanding intra-annular (Portico, n = 110), self-expanding supra-annular (Evolut, n = 179 and Acurate-Neo, n = 428) and mechanically expanding infra-annular (Lotus, n = 64) THV according to local practice. PPM was defined as indexed effective orifice area <= 0.85cm(2)/m(2). Results A small annulus was found in 1069 (12.7%) patients. PPM was detected in 38.3% overall with a higher prevalence after implantation of a balloon-expanding intra-annular or mechanically expanding infra-annular THV compared to self-expanding intra- and supra-annular THV. Multivariable analysis linked self-expanding THV (Evolut: Odds ratio [OR] 0.341, Acurate-Neo: OR 0.436, Portico: OR 0.291), postdilatation (OR 0.648) and age (OR 0.968) to lower rates of PPM, while aortic valve calcification was associated with an increased risk (OR 1.001). Paravalvular regurgitation > mild was more frequent after TAVI with self-expanding THV (p = 0.04). Conclusion In this large contemporary multicenter patient population, a substantial number of patients with a small aortic anatomy were left with PPM after TAVI. Self-expanding supra- and intra-annular THV demonstrated superior hemodynamics in these patients at risk, however at the cost of higher rates of residual paravalvular regurgitation. Graphic abstract

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Voigtlaender, Lisa UNSPECIFIED UNSPECIFIED UNSPECIFIED Kim, Won-Keun UNSPECIFIED UNSPECIFIED UNSPECIFIED Mauri, Victor UNSPECIFIED UNSPECIFIED UNSPECIFIED Gossling, Alina UNSPECIFIED UNSPECIFIED UNSPECIFIED Renker, Matthias UNSPECIFIED UNSPECIFIED UNSPECIFIED Sugiura, Atsushi UNSPECIFIED UNSPECIFIED UNSPECIFIED Linder, Matthias UNSPECIFIED UNSPECIFIED UNSPECIFIED Schmidt, Tobias UNSPECIFIED UNSPECIFIED UNSPECIFIED Schofer, Niklas UNSPECIFIED UNSPECIFIED UNSPECIFIED Westermann, Dirk UNSPECIFIED UNSPECIFIED UNSPECIFIED Reichenspurner, Hermann UNSPECIFIED UNSPECIFIED UNSPECIFIED Nickenig, Georg UNSPECIFIED UNSPECIFIED UNSPECIFIED Blankenberg, Stefan UNSPECIFIED UNSPECIFIED UNSPECIFIED Hamm, Christian UNSPECIFIED UNSPECIFIED UNSPECIFIED Conradi, Lenard UNSPECIFIED UNSPECIFIED UNSPECIFIED Adam, Matti UNSPECIFIED UNSPECIFIED UNSPECIFIED Sinning, Jan-Malte UNSPECIFIED UNSPECIFIED UNSPECIFIED Seiffert, Moritz UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-584418
DOI:	10.1007/s00392-021-01918-8
Journal or Publication Title:	Clin. Res. Cardiol.
Volume:	110
Number:	12
Page Range:	S. 1957 - 1967
Date:	2021
Publisher:	SPRINGER HEIDELBERG
Place of Publication:	HEIDELBERG
ISSN:	1861-0692
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language MISMATCH; REPLACEMENT; OUTCOMES; IMPACT Multiple languages Cardiac & Cardiovascular Systems Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/58441