Author + information
- Received October 15, 2008
- Revision received January 6, 2009
- Accepted January 25, 2009
- Published online May 19, 2009.
- Marie-Annick Clavel, DVM, MSc*,
- John G. Webb, MD†,
- Philippe Pibarot, DVM, PhD*,
- Lukas Altwegg, MD†,
- Eric Dumont, MD*,
- Chris Thompson, MD†,
- Robert De Larochellière, MD*,
- Daniel Doyle, MD*,
- Jean-Bernard Masson, MD†,
- Sebastien Bergeron, MD*,
- Olivier F. Bertrand, MD, PhD* and
- Josep Rodés-Cabau, MD*,* ()
- ↵*Reprint requests and correspondence:
Dr. Josep Rodés-Cabau, Quebec Heart & Lung Institute/Laval Hospital, 2725 Chemin Ste-Foy, Québec City, Quebec G1V 4G5, Canada
Objectives This study was undertaken to compare the hemodynamic performance of a percutaneous bioprosthesis to that of surgically implanted (stented and stentless) bioprostheses for the treatment of severe aortic stenosis.
Methods Fifty patients who underwent percutaneous aortic valve implantation (PAVI) with the Cribier-Edwards or Edwards SAPIEN bioprosthetic valve (Edwards Lifesciences, Inc., Irvine, California) were matched 1:1 for sex, aortic annulus diameter, left ventricular ejection fraction, body surface area, and body mass index, with 2 groups of 50 patients who underwent surgical aortic valve replacement (SAVR) with a stented valve (Edwards Perimount Magna [SAVR-ST group]), or a stentless valve (Medtronic Freestyle, Medtronic, Minneapolis, Minnesota [SAVR-SL group]). Doppler echocardiographic data were prospectively obtained before the intervention, at discharge, and at 6- to 12-month follow-up.
Results Mean transprosthetic gradient at discharge was lower (p < 0.001) in the PAVI group (10 ± 4 mm Hg) compared with the SAVR-ST (13 ± 5 mm Hg) and SAVR-SL (14 ± 6 mm Hg) groups. Aortic regurgitation (AR) occurred more frequently in the PAVI group (mild: 42%, moderate: 8%) compared with the SAVR-ST (mild: 10%, moderate: 0%) and SAVR-SL (mild: 12%, moderate: 0%) groups (p < 0.0001). At follow-up, the mean gradient in the PAVI group remained lower (p < 0.001) than that of the SAVR-ST group, but was similar to that of the SAVR-SL group. The incidence of severe prosthesis-patient mismatch was significantly lower (p = 0.007) in the PAVI group (6%) compared with the SAVR-ST (28%) and SAVR-SL (20%) groups. However, the incidence of AR remained higher (p < 0.0001) in the PAVI group compared with the 2 other groups.
Conclusions PAVI provided superior hemodynamic performance compared with the surgical bioprostheses in terms of transprosthetic gradient and prevention of severe prosthesis-patient mismatch, but was associated with a higher incidence of AR.
- aortic stenosis
- heart valve prosthesis
- percutaneous aortic valve implantation
- aortic valve replacement
This study was funded, in part, by a grant (MOP 57745) of the Canadian Institutes of Health Research, Ottawa, Ontario, Canada. Dr. Pibarot holds the Canada Research Chair in Valvular Heart Disease, Canadian Institutes of Health Research, and has received honoraria from Edwards Lifesciences, Inc., Sorin Medical, St. Jude Medical, and Medtronic. Dr. Rodés-Cabau is a consultant for Edwards Lifesciences, Inc. Dr. Webb is a consultant to Edwards Lifesciences, Inc., St. Jude Medical, Guided Delivery Systems, and Kardium. Dr. Dumont served in a proctorship for transapical aortic valve replacement for Edwards Lifesciences, Inc.
- Received October 15, 2008.
- Revision received January 6, 2009.
- Accepted January 25, 2009.
- American College of Cardiology Foundation