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. 2021 Mar;51(3):222-231.
doi: 10.4070/kcj.2020.0409.

Comparison of Transcatheter Aortic Valve Replacement between Self-Expanding versus Balloon-Expandable Valves in Patients with Small Aortic Annulus

Yong Joon Lee  1 , Seung Jun Lee  1 , Sung Jin Hong  1 , Chi Young Shim  1 , Chul Min Ahn  1 , Jung Sun Kim  1 , Byeong Keuk Kim  1 , Geu Ru Hong  1 , Young Guk Ko  1 , Donghoon Choi  1 , Yangsoo Jang  1 , Myeong Ki Hong  2
Affiliations

Comparison of Transcatheter Aortic Valve Replacement between Self-Expanding versus Balloon-Expandable Valves in Patients with Small Aortic Annulus

Yong Joon Lee et al. Korean Circ J. 2021 Mar.

Abstract

Background and objectives: Transcatheter aortic valve replacement (TAVR) has been reported as a good alternative for surgical aortic valve replacement in patients with small aortic annulus. Head-to-head comparisons of different transcatheter aortic valves in these patients are insufficient. We compared the outcomes after TAVR between two different types of recent transcatheter aortic valves (self-expanding vs. balloon-expandable) in patients with small aortic annulus.

Methods: A total of 70 patients with severe aortic stenosis and small annulus (mean diameter ≤23 mm or minimal diameter ≤21 mm on computed tomography) underwent TAVR with either a self-expanding valve with supra-annular location (n=45) or a balloon-expandable valve with intra-annular location (n=25). The echocardiographic hemodynamic parameters after TAVR and 1-year follow-up were compared.

Results: Between the self-expanding and balloon-expandable valve-treated patients, the clinical outcomes including permanent pacemaker implantation (11.1% vs. 8.0%), acute kidney injury stage 2 or 3 (4.4% vs. 4.0%), and major vascular complication (4.4% vs. 0.0%) were similar without all-cause mortality, stroke, and life-threatening bleeding during 30-day follow-up. Compared with the balloon-expandable valve-treated patients, the self-expanding valve-treated patients presented larger effective orifice area (EOA) (1.46±0.28 vs. 1.75±0.42 cm², p=0.002) and indexed EOA (0.95±0.21 vs. 1.18±0.28 cm²/m², p=0.001), whereas mean aortic valve gradient (11.7±2.9 vs. 8.9±5.2 mmHg, P=0.005) and incidence of ≥moderate prosthesis-patient mismatch (36.0% vs. 8.9%, p=0.009) were lower. These hemodynamic differences were maintained at 1-year follow-up.

Conclusions: TAVR with self-expanding valves was associated with superior hemodynamic outcomes compared with balloon-expandable valves in patients with small aortic annulus.

Keywords: Aortic valve stenosis; Transcatheter aortic valve replacement.

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Conflict of interest statement

MK Hong and YG Ko are proctors of Medtronic. The other authors have no financial conflicts of interest.

Figures

Figure 1
Figure 1. Echocardiographic outcomes at baseline, discharge, and 1-year follow-up.
Effective orifice area (A), indexed effective orifice area (B), and mean aortic valve pressure gradient (C). EOA = effective orifice area; iEOA = indexed effective orifice area.
Figure 2
Figure 2. Incidence of prosthesis-patient mismatch and paravalvular leak at discharge and 1-year follow-up.
Prosthesis-patient mismatch (A) and paravalvular leak (B). There was no severe paravalvular leak during 1-year follow-up.
See this image and copyright information in PMC

References

    1. Kalavrouziotis D, Rodés-Cabau J, Bagur R, et al. Transcatheter aortic valve implantation in patients with severe aortic stenosis and small aortic annulus. J Am Coll Cardiol. 2011;58:1016–1024. - PubMed
    1. Pibarot P, Weissman NJ, Stewart WJ, et al. Incidence and sequelae of prosthesis-patient mismatch in transcatheter versus surgical valve replacement in high-risk patients with severe aortic stenosis: a PARTNER trial cohort--a analysis. J Am Coll Cardiol. 2014;64:1323–1334. - PMC - PubMed
    1. Nishimura RA, Otto CM, Bonow RO, et al. 2017 AHA/ACC Focused Update of the 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2017;135:e1159–95. - PubMed
    1. Baumgartner H, Falk V, Bax JJ, et al. 2017 ESC/EACTS Guidelines for the management of valvular heart disease. Eur Heart J. 2017;38:2739–2791. - PubMed
    1. Mauri V, Kim WK, Abumayyaleh M, et al. Short-term outcome and hemodynamic performance of next-generation self-expanding versus balloon-expandable transcatheter aortic valves in patients with small aortic annulus: a multicenter propensity-matched comparison. Circ Cardiovasc Interv. 2017;10:e005013. - PubMed

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