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. 2022 Nov;100(5):823-831.
doi: 10.1002/ccd.30402. Epub 2022 Sep 24.

Bespoke valve sizing avoids annular rupture in patients treated with a balloon-expandable transcatheter heart valve

Jorge Chavarria  1 , Felipe Falcao  1 , Gustavo Dutra  1 , Janarthanan Sathananthan  2 , David Wood  2 , Georgia Douvi  1 , Madhu Natarajan  1   3 , Iqbal Jaffer  1 , James Velianou  1 , Tej Sheth  1   3
Affiliations

Bespoke valve sizing avoids annular rupture in patients treated with a balloon-expandable transcatheter heart valve

Jorge Chavarria et al. Catheter Cardiovasc Interv. 2022 Nov.

Abstract

Background: Annular and left ventricular outflow tract (LVOT) calcification increase the risk of annular rupture following transcatheter aortic valve replacement (TAVR). The outcomes of a strategy of routine use of a balloon-expandable valve (BEV) for all patients irrespective of annular or LVOT calcium is unknown.

Objectives: We evaluated the impact of bespoke sizing on annular rupture in patients treated with a BEV.

Methods: All consecutive patients undergoing TAVR at a single centre (February 2020-February 2022) were treated only with a BEV. No other valve design was used. Annular/LVOT calcification was assessed using a standardized grading system. For each annular area, we determined the percentage valve oversizing with nominal deployment. The balloon deployment volume was then adjusted when required (over-/underfilled) to achieve over-sizing of approximately 5% in the presence of annular/LVOT calcium and 5%-10% in the absence of annular/LVOT calcium. Adjusted valve areas were assumed to change proportionately to the change in balloon deployment volume.

Results: Among 533 TAVR treated patients, annular/LVOT calcification was present in 166 (31.1%) and moderate or severe in 90 (16.9%). In patients with annular/LVOT calcification, the adjusted oversizing was 3.5 ± 3.6% and in patients without annular/LVOT calcification, the adjusted oversizing was 6.8 ± 4.7% (p < 0.001). There were no cases of annular rupture and no cases with more than mild paravalvular leak (PVL). Mild PVL was more frequent in patients with annular/LVOT calcium (10.8% vs 4.6%, p = 0.01).

Conclusion: Bespoke BEV sizing by adjustment of balloon deployment volume avoided annular rupture in patients undergoing TAVR.

Keywords: LVOT calcification; TAVR; annular rupture; paravalvular leak.

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References

REFERENCES

    1. Okuno T, Asami M, Heg D, et al. Impact of left ventricular outflow tract calcification on procedural outcomes after transcatheter aortic valve replacement. J Am Coll Cardiol. 2020;13(15):1789-1799. doi:10.1016/j.carrev.2021.07.010
    1. Jochheim D, Deseive S, Gschwendtner S, et al. Impact of severe left ventricular outflow tract calcification on device failure and short-term mortality in patients undergoing TAVI. J Cardiovasc Comput Tomogr. 2020;14(1):36-41. doi:10.1016/j.jcct.2019.07.004
    1. Braghiroli J, Kapoor K, Thielhelm TP, Ferreira T, Cohen MG. Transcatheter aortic valve replacement in low risk patients: a review of PARTNER 3 and Evolut low risk trials. Cardiovasc Diagn Ther. 2020;10(1):59-71. doi:10.21037/cdt.2019.09.12
    1. Popma JJ, Deeb GM, Yakubov SJ, et al. Evolut low risk trial investigators. transcatheter aortic-valve replacement with a self-expanding valve in low-risk patients. N Engl J Med. 2019;380(18):1706-1715. doi:10.1056/NEJMoa1816885
    1. Mack MJ, Leon MB, Thourani VH, et al. PARTNER 3 investigators. transcatheter aortic-valve replacement with a balloon-expandable valve in low-risk patients. N Engl J Med. 2019;380(18):1695-1705. doi:10.1056/NEJMoa1814052

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