Author + information
- Daniel O'Hair1,
- Renuka Jain2,
- Amanda Kirby3,
- Jayant Khitha4,
- Bijoy Khandheria2,
- Suhail Allaqaband1 and
- Tanvir Bajwa5
- 1Aurora Medical Group, Milwaukee, Wisconsin, United States
- 2Aurora Medical Group
- 3Aurora St Luke's Medical Center, Milwaukee, Wisconsin, United States
- 4Aurora medical group, Mequon, Wisconsin, United States
- 5Aurora Cardiovascular Services, Aurora Sinai/Aurora St. Lukes's Medical Centers, Brookfield, Wisconsin, United States
Successful transcatheter aortic valve replacement (TAVR) includes the avoidance of paravalvular leak. Self-expanding valves naturally conform to irregularly shaped native anatomy and this report describes the initial experience with addition of a pericardial wrap designed to minimize paravalvular leak.
Patients with severe symptomatic aortic stenosis were evaluated by a heart team and deemed to be at high risk for surgical intervention and underwent TAVR using the Evolut Pro device (Medtronic, Minneapolis, MN) at a single institution between March and June of 2017. The procedural and thirty day outcomes are reported.
The Evolut PRO Transcatheter Aortic Valve (TAV) was implanted in 45 patients during the study period. The mean age of patient population was 83.5 (6.7) years, and 31 (68.9%) were female. Mean STS-PROM was 6.1%. Forty-four patients underwent implantation for severe native aortic stenosis, 1 patient underwent implantation for bioprosthetic aortic valve stenosis. Conscious sedation was used in 41/45 cases (92%). All patients underwent successful procedures – 42 patients had transfemoral access, 2 suprasternal access, and 1 patient had direct aortic access. Valve sizes used were 23mm (3 patients), 26mm (12 patients), and 29mm (30 patients). There were no procedural complications and all patients survived to hospital discharge. Paravalvular leak was mild or less in 43/44 (98%) of the patients. Permanent pacemaker implant was required in 4 patients (8.9%). There was no mortality. Thirty day follow up ECHO showed no changes. Post procedural ECHO findings are listed in the Table.
|Variables||Pre-Procedure||24 Hours Post-Procedure||p-Value|
|Aortic Valve Orifice Area, Mean (SD)||0.75 (0.18)||2.23 (0.69)||<0.001|
|Aortic Valve Orifice Area Index, Mean (SD)||0.38 (0.10)||1.17 (0.42)||<0.001|
|Aortic Valve Mean Gradient, Mean (SD)||39.94 (15.82)||9.20 (5.70)||<0.001|
|Aortic Valve Peak Velocity, Mean (SD)||4.10 (0.78)||2.05 (0.46)||<0.001|
|Paravalvular Leak, n (%)|
In the largest real world report of TAVR with Evolut Pro TAV device, implant using conscious sedation was marked by high procedural success rate, minimal paravalvular leak and infrequent need for permanent pacemaker.
STRUCTURAL: Valvular Disease: Aortic