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:
CreatorsEmailORCIDORCID Put Code
Voigtlaender, LisaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Kim, Won-KeunUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Mauri, VictorUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Gossling, AlinaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Renker, MatthiasUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Sugiura, AtsushiUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Linder, MatthiasUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Schmidt, TobiasUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Schofer, NiklasUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Westermann, DirkUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Reichenspurner, HermannUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Nickenig, GeorgUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Blankenberg, StefanUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Hamm, ChristianUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Conradi, LenardUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Adam, MattiUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Sinning, Jan-MalteUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Seiffert, MoritzUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
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:
KeywordsLanguage
MISMATCH; REPLACEMENT; OUTCOMES; IMPACTMultiple languages
Cardiac & Cardiovascular SystemsMultiple languages
URI: http://kups.ub.uni-koeln.de/id/eprint/58441

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