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Transcatheter aortic valve implantation in patients with a small aortic annulus: performance of supra-, intra- and infra-annular transcatheter heart valves
Clinical Research in Cardiology ( IF 5 ) Pub Date : 2021-08-13 , DOI: 10.1007/s00392-021-01918-8
Lisa Voigtländer 1, 2 , Alina Goßling 1 , Matthias Linder 1, 2 , Niklas Schofer 1, 2 , Dirk Westermann 1, 2 , Stefan Blankenberg 1, 2 , Moritz Seiffert 1, 2 , Won-Keun Kim 3 , Matthias Renker 3 , Christian Hamm 3 , Victor Mauri 4 , Tobias Schmidt 4 , Matti Adam 4 , Atsushi Sugiura 5 , Georg Nickenig 5 , Jan-Malte Sinning 5 , Hermann Reichenspurner 2, 6 , Lenard Conradi 2, 6
Affiliation  

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 mm2. 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 ≤ 0.85cm2/m2.

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



中文翻译:

小主动脉瓣环患者的经导管主动脉瓣植入术:环上、环内和环下经导管心脏瓣膜的性能

背景

小主动脉瓣环与经导管主动脉瓣植入 (TAVI) 后假体与患者不匹配 (PPM) 的风险增加有关。特定的经导管心脏瓣膜 (THV) 设计是否在这些小解剖结构中产生卓越的血流动力学性能仍不清楚。

方法

回顾性评估了 2012 年 5 月至 2019 年 4 月在德国四个中心接受 TAVI 治疗的 8411 名连续患者的数据。小主动脉瓣环定义为多探测器计算机断层扫描衍生的瓣环面积 < 400 mm 2。TAVI 使用球囊扩张环内(Sapien-3,n  = 288)、自扩张环内(Portico,n  = 110)、自扩张超环(Evolut,n  = 179 和 Acurate- Neo, n  = 428) 和机械膨胀的环下 (Lotus, n  = 64) THV 根据当地实践。PPM 定义为索引有效孔口面积≤ 0.85cm 2 /m 2

结果

在 1069 名 (12.7%) 患者中发现了一个小环。与自膨式环内和环上 THV 相比,在植入球囊扩张环内或机械扩张环下 THV 后,总体检测到 PPM 率为 38.3%,患病率更高。多变量分析将自膨式 THV(Evolut:优势比 [OR] 0.341,Acurate-Neo:OR 0.436,Portico:OR 0.291)、后扩张(OR 0.648)和年龄(OR 0.968)与较低的 PPM 率相关联,而主动脉瓣钙化与风险增加有关(OR 1.001)。TAVI 自膨式 THV 后瓣周反流 > 轻度更频繁 ( p  = 0.04)。

结论

在这一庞大的当代多中心患者群体中,大量主动脉解剖结构较小的患者在 TAVI 后仍存在 PPM。自扩张环上和环内 THV 在这些有风险的患者中表现出优异的血流动力学,但代价是残余瓣周反流率较高。

图形摘要

更新日期:2021-08-19
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