Abstract
ObjectivesTo compare the quantitative angiographic aortic regurgitation (AR) of six self-expanding valves after transcatheter aortic valve replacement (TAVR).BackgroundQuantitative videodensitometric aortography (LVOT-AR) is an accurate and reproducible tool for assessment of AR following TAVR.MethodsThis is a retrospective central core-lab analysis of 1,257 consecutive cine aortograms performed post-TAVR. The study included 107 final aortograms of consecutive patients who underwent TAVR with first-generation VitaFlow in four Chinese centers and 1,150 aortograms with five other transcatheter aortic valves (Evolut Pro, Evolut R, CoreValve, Venus A-Valve, and Acurate Neo). LVOT-AR analyses of these five valves were retrieved from a previously published pooled database.ResultsAmong 172 aortograms of patients treated with VitaFlow, 107 final aortograms (62.2%) were analyzable by LVOT-AR. In this first in man eight cases necessitated a procedural valve in valve due to inappropriate TAVR positioning and severe aortic paravalvular regurgitation. In the VitaFlow group, the mean LVOT-AR of the intermediate aortograms was 7.3 ± 7.8% and the incidence of LVOT-AR >17% was 8.6%. The mean LVOT-AR of the final aortogram was 6.1 ± 6.4% in the VitaFlow group, followed by Evolut Pro (7.3 ± 6.5%), Evolut R (7.9 ± 7.4%), Venus A-valve (8.9 ± 10.0%), Acurate Neo (9.6 ± 9.2%), and lastly CoreValve (13.7 ± 10.7%) (analysis of variance p < 0.001). Post hoc 2-by-2 testing showed that CoreValve had significantly higher LVOT-AR compared with each of the other five THVs. No statistical difference in LVOT-AR was observed between VitaFlow, Evolut Pro, Evolut R, Acurate Neo, and Venus A-valves. The VitaFlow system had the lowest proportion of patients with LVOT-AR >17% (4.7%) (AR after the final aortograms), followed by Evolut Pro (5.3%), Evolut R (8.8%), Acurate Neo (11.3%), Venus A-valve (14.2%), and CoreValve (30.1%) (chi-square p < 0.001).ConclusionCompared to other commercially available self-expanding valves, VitaFlow seems to have a low degree of AR and a low proportion of patients with ≥moderate/severe AR as assessed by quantitative videodensitometric angiography. Once the learning phase is completed, comparisons of AR between different transcatheter heart valves should be attempted in a prospective randomized trial.
Highlights
Moderate or severe aortic regurgitation (AR) post transcatheter aortic valve replacement (TAVR) is associated with increased long-term mortality [1, 2], accurate procedural assessment of AR is critical for long term results of TAVR
Out of 172 aortograms of patients treated with VitaFlow transcatheter heart valve (THV), 107 final aortograms (62.2%) were analyzable by quantitative assessment of AR
Out of 65 non-analyzable cases, the reasons for non-analyzable were as follows: overlapping of the descending aorta with LVOT (n = 33, 50.8%) overlapping of the descending aorta on ascending aorta (n = 19, 29.2%), duration of the acquisition is too short (n = 3, 4.6%), deep breathing or table motion (n = 3, 4.6%), insufficient contrast (n = 3, 4.6%), radiopaque structure in LOVT (n = 2, 3.1%), others (n = 2, 3.1%). In this first in man experience 8 cases nessessitate a valve in valve treatment due to inappropriate positioning of the valve resulting in severe aortic paravalvular regurgitation
Summary
Moderate or severe aortic regurgitation (AR) post transcatheter aortic valve replacement (TAVR) is associated with increased long-term mortality [1, 2], accurate procedural assessment of AR is critical for long term results of TAVR. Quantitative videodensitometric assessment of paravalvular leak (PVL) has been extensively vetted and validated in-vitro [3, 4], in-vivo [5], and in the clinical setting, such as after TAVR [6,7,8,9,10,11,12,13,14,15,16,17,18], and quantitative videodensitometric aortography is an objective, accurate, and reproducible tool for assessment of AR following TAVR that has been advocated, among other techniques, in the VARC three consensus as a reliable modality of AR assessment [19]. Quantitative videodensitometric aortography (LVOT-AR) is an accurate and reproducible tool for assessment of AR following TAVR
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