• Impact of device-host interaction on paravalvular aortic regurgitation with different transcatheter heart valves

    Abstract

    Aims

    We sought to evaluate the interaction of different aortic root phenotypes with self-expanding (SEV), balloon-expandable (BEV) and mechanically expanded (MEV) and the impact on significant aortic regurgitation.

    Methods and results

    We included 392 patients with a SEV ( = 205), BEV ( = 107) or MEV ( = 80). Aortic annulus eccentricity index and calcification were measured by multi-slice CT scan. Paravalvular aortic regurgitation was assessed by contrast aortography (primary analysis) and transthoracic echocardiography (secondary analysis).

    In mildly calcified roots paravalvular regurgitation incidence was similar for all transcatheter heart valves (SEV 8.4%; BEV 9.1%; MEV 2.0% = 0.27). Conversely, in heavily calcified roots paravalvular regurgitation incidence was significantly higher with SEV ( SEV 45.9%; BEV 0.0%; MEV 0.0% p < 0.001 ). When paravalvular regurgitation was assessed by TTE, the overall findings were similar although elliptic aortic roots were associated with more paravalvular regurgitation with SEV (20.5% vs. BEV 4.5% vs. MEV 3.2%; = 0.009).

    Conclusions

    In heavily calcified aortic roots, significant paravalvular aortic regurgitation is more frequent with SEV than with BEV or MEV, but similar in mildly calcified ones. These findings may support patient-tailored transcatheter heart valve selection.

    Classifications

    Aortic stenosis; multislice computed tomography; transcatheter aortic valve replacement; paravalvular aortic regurgitation.

    Condensed abstract

    We sought to evaluate the interaction of different aortic root phenotypes with self-expanding (SEV), balloon-expandable (BEV) and mechanically expanded (MEV) and the impact on significant aortic regurgitation. We included 392 patients with a SEV ( = 205), BEV ( = 107) or MEV ( = 80). Aortic annulus eccentricity index and calcification were measured by multi-slice CT scan. Paravalvular aortic regurgitation was assessed by contrast aortography and transthoracic echocardiography. We found that in heavily calcified aortic roots, significant paravalvular aortic regurgitation is more frequent with SEV than with BEV or MEV, but similar in mildly calcified ones.

    Author bio

    Cardiovascular Revascularization Medicine, 2019-02-01, Volume 20, Issue 2, Pages 126-132, Copyright © 2018 Elsevier Inc.

     

    Source:

    Read the original article on Science Direct: Impact of device-host interaction on paravalvular aortic regurgitation with different transcatheter heart valves

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