1625prosthetic valve regurgitation after transcatheter aortic valve implantation with new-generation devices compared to surgical aortic valve replacement–a cardiac magnetic resonance imaging flow measurement analysis

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Background: Transcatheter aortic valve implantation (TAVI) has become a widely used alternative for patients with severe symptomatic aortic stenosis who are considered to be at high risk for cardiac surgery. Post-TAVI paravalvular aortic regurgitation (AR) has been frequently observed, whereas AR after surgical aortic valve replacement (SAVR) is thought to be a rare finding. However, contemporary transcatheter valves have been modified to prevent relevant paravalvular leaks. Cardiac magnetic resonance imaging (MRI) is a non-invasive, observer-independent method for the quantification of post-TAVI AR, and has been shown to be more reliable than echocardiography. Thus, we sought to compare the frequency and severity of AR after TAVI with new-generation devices compared to SAVR. Methods: Patients aged over 65 years who underwent transfemoral TAVI using the Edwards Sapien 3 valve or the Lotus valve and patients who underwent SAVR using bioprosthetic valves between July 2014 and September 2015 and who had no contraindications for MRI were included into the analysis. TAVI patients underwent cardiac MRI at a median of 10 days after valve implantation and the SAVR patients at a mean of 24 days after surgery. Phase-contrast MRI was conducted to quantify the degree of AR. A calculated regurgitant fraction (RF) ≤15% was graded as I (mild), 16–30% as II (moderate), 31–50% as III (moderate to severe) and > 50% as grade IV (severe) AR, a RF Results: 56 patients were included into the TAVI group and 30 patients into the SAVR group. TAVI patients were significantly older than SAVR patients (80.6 ± 7.1 years vs. 74.1 ± 4.4 years, p Conclusions: Using MRI flow measurements, patients treated with new-generation transcatheter aortic valves with an adaptive seal have similar rates of paravalvular AR compared to patients treated with surgical aortic valve replacement.