Abstract
ABSTRACTBackgroundCommissural misalignment (CMA) has demonstrated to difficult future coronary access in self‐expandable prosthesis and has been related with subclinical leaflet thrombosis and a potential increase in valve gradients and aortic regurgitation at follow‐up.AimsThe aim of our study was to assess the commissural alignment of the balloon expandable SAPIEN 3 valve (Edwards Lifesciences) and to evaluate its impact on transvalvular gradient and mortality at 5 years of follow‐up.MethodsConsecutive patients treated with SAPIEN 3 prosthesis guided with intraprocedural transesophageal echocardiogram (TEE) with a minimal follow‐up of 5 years were included. Commissural alignment between the prosthesis and the native valve was measured by TEE by two independent cardiologists using a standardized 3‐cusp view pre and post‐valve deployment. CMA was defined as a neocommissure deviation > 30° compared with native commissures. Echocardiographic gradients and clinical events were recorded during follow‐up and compared between groups.ResultsOne hundred and five patients (54% male, mean age 80.4 years) were included; 63 (40%) were classified as “aligned” (CMA < 30°) and 42 (60%) as “misaligned” (CMA > 30°). Patients with CMA > 30° presented smaller aortic annulus (23.8 vs. 20.7, p < 0.01) and received smaller valves. There was a slight increase of mean transvalvular gradient during follow‐up (9.2−10.3 mmHg, p < 0.05), without significant differences between groups. Mortality rate was 16.2% at 1 year and 49.5% at 5 years; and not related to commissural alignment.ConclusionsSignificant CMA is present in 40% of patients treated with SAPIEN 3 valves, however, we didn't find a significant association between CMA and gradient increase or mortality during long‐term follow‐up.
Published Version
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call