Author + information
- Daniel Mangels1,
- Mary Siki2,
- Rohan Menon3,
- Joseph Bavaria2,
- Saif Anwaruddin2,
- Jay Giri4,
- Nimesh Desai1,
- Wilson Y. Szeto2,
- Prashanth Vallabhajosyula2 and
- Howard Herrmann2
Eccentric valve deployment after transcatheter aortic valve replacement (TAVR) has been associated with abnormal leaflet shear stresses that may accelerate structural valve deterioration (SVD). This phenomenon has not been studied in patients receiving Sapien 3 prostheses.
A retrospective cohort analysis of 100 patients who received Sapien 3 valves between 2013 and 2015 at a single institution was performed. Pre-operative CT angiography was used to calculate eccentricity indices of the aortic annulus. Axial fluoroscopic images in the co-planar view were used to assess post procedure valve asymmetry, which was defined as a ratio of left-to-right valve heights ≤0.9 or ≥1.1. Transthoracic echocardiograms (TTE) were obtained at follow-up to analyze peak and mean aortic valve (AV) gradients, paravalvulvar leak (PVL), and aortic insufficiency (AI).
Complete TTE data was available in 99%, 75% and 39% at discharge, 1-year and 2-year follow-up, respectively. Overall, 26 mm and 29 mm valves had greater asymmetry (45.16% and 45.39%) compared to 23 mm valves (21.62%; p= 0.05). There was no relationship between pre-TAVR eccentricity and post-TAVR asymmetry. Although asymmetry was associated with higher mean and peak AV gradients amongst 23 mm and 26 mm valves at both 1-year and 2-year follow-up, these results did not reach significance. Table 1 summarizes the mean AV gradients. There were no significant differences in PVL or AI severity between asymmetric and symmetric valves.
|Valve Size (mm)||Asymmetry||Discharge (mmHg)||One-Year (mmHg)||Two-Year (mmHg)|
|23||Symmetric||13.18 (p= 0.43)||13.95 (p= 0.19)||11.69 (p= 0.11)|
|26||Symmetric||13.24 (p= 0.19)||10.72 (p= 0.19)||9.29 (p= 0.17)|
|29||Symmetric||10.39 (p= 0.19)||10.40 (p= 0.01)||10.5 (p= 0.14)|
Asymmetric deployment of Sapien 3 valves is common, particularly amongst 26 and 29 mm prostheses. Aortic annular eccentricity is not associated with increased Sapien 3 asymmetry. We found a small increase in gradients in smaller prostheses that could reflect early subclinical SVD. Longer follow up will be necessary to determine the extent to which eccentricity may be associated with clinically significant SVD.
STRUCTURAL: Valvular Disease: Aortic