Author + information
- Fumiaki Yashima,
- Masanori Yamamoto,
- Makoto Tanaka,
- Ryo Yanagisawa,
- Takahide Arai,
- Keiichi Fukuda,
- Yusuke Watanabe,
- Toru Naganuma,
- Shinichi Shirai,
- Motoharu Araki,
- Norio Tada,
- Futoshi Yamanaka and
- Kentaro Hayashida
Background: Transcatheter aortic valve implantation (TAVI) has been reported to be advantageous over surgical aortic valve replacement owing to the low incidence of prosthesis-patient mismatch (PPM) and large effective orifice area (EOA). However, data on TAVI for an extremely small annulus are limited. The present study aimed to compare post-procedural hemodynamics and morphology between 20-mm and 23-mm Sapien XT (SXT) transcatheter heart valves (THVs) with an extremely small annulus (<314 mm2) using post-procedural echocardiography and multidetector computed tomography.
Methods: All patients with severe aortic stenosis treated with TAVI at 8 Japanese centers between October 2013 and January 2016 were prospectively included in the Optimized CathEter vAlvular iNtervention (OCEAN-TAVI) registry. In the overall cohort of 20-mm (19 patients) and 23-mm SXTs (492 patients) with an extremely small annulus, the patient groups were matched one-to-one by using propensity scores, and post-procedural echocardiography and multidetector computed tomography data were compared for 18 matched patients from each group (matched cohort).
Results: In the matched cohort, the mean gradient was higher (15.4±4.1 vs. 12.2±4.8 mmHg, p=0.04), EOA was lower (1.22±0.25 vs. 1.44±0.37 cm2, p=0.02), and THV area was lower (245.6±19.1 vs. 298.5±33.3 mm2, p<0.01) in the 20-mm group than in the 23-mm group. However, these appeared to be subclinical. Although moderate PPM was more prevalent in the 20-mm group than in the 23-mm group (31.6% vs. 7.9%, p<0.01), the incidence of severe PPM was low and similar between the groups (0% vs. 0.4%, p=1.00) in the overall cohort.
Conclusions: In patients with an extremely small native aortic annulus, the transvalvular gradient is higher, EOA is lower, and THV area is lower with a 20-mm SXT than with a 23-mm SXT, even after matching. However, the differences appear to be subclinical, and the incidence of severe PPM, which can influence prognosis, might be very low. Therefore, the 20-mm SXT appears to be effective in patients who require such a small bioprosthesis.
Poster Hall, Hall C
Sunday, March 19, 2017, 9:45 a.m.-10:30 a.m.
Session Title: Interventional Cardiology: TAVR 4
Abstract Category: 17. Interventional Cardiology: Aortic Valve Disease
Presentation Number: 1283-144
- 2017 American College of Cardiology Foundation