Effective Orifice Area of Balloon-Expandable and Self-Expandable Transcatheter Aortic Valve Prostheses: An Echo Doppler Comparative Study.

Mohamad Kanso,Patrick Ohlmann,Kensuke Matsushita,Olivier Morel,Hélène Petit,Minh Hoang,Michel Kindo,Annie Trinh,Pierre Leddet,Fabien De Poli,Jérome Rischner,Philoktimon Plastaras,Marion Kibler,Sebastien Hess,Floriane Zeyons

doi:10.3390/jcm10020186

Mohamad Kanso, Patrick Ohlmann + Show 13 more

Open Access

https://doi.org/10.3390/jcm10020186

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Abstract

Published data on the size-specific effective orifice area (EOA) of transcatheter heart valves (THVs) remain scarce. Here, we sought to investigate the intra-individual changes in EOA and mean transvalvular aortic gradient (MG) of the Sapien 3 (S3), CoreValve (CV), and Evolut R (EVR) prostheses both at short-term and at 1-year follow-up. The study sample consisted of 260 consecutive patients with severe aortic stenosis who underwent transcatheter aortic valve implantation (TAVI). EOAs and MGs were measured with Doppler echocardiography for the following prostheses: S3 23 mm (n = 74; 28.5%), S3 26 mm (n = 67; 25.8%), S3 29 mm (n = 20; 7.7%), CV 23 mm (n = 2; 0.8%), CV 26 mm (n = 15; 5.8%), CV 29 mm (n = 24; 9.2%), CV 31 mm (n = 9; 3.5%), EVR 26 mm (n = 22; 8.5%), and EVR 29 mm (n = 27; 10.4%). Values were obtained at discharge, 1 month, 6 months, and 1 year from implantation. At discharge, EOAs were larger and MGs lower for larger-size prostheses, regardless of being balloon-expandable or self-expandable. In patients with small aortic annulus size, the hemodynamic performances of CV and EVR prostheses were superior to those of S3. However, we did not observe significant differences in terms of all-cause mortality according to THV type or size. Both balloon-expandable and self-expandable new-generation THVs show excellent hemodynamic performances without evidence of very early valve degeneration.

Highlights

In order to increase the sample size for certain specific prostheses (CV 31 mm, Evolut R (EVR) 26 mm, and EVR 29 mm), we screened for eligibility another group of 86 consecutive patients who were treated with transcatheter aortic valve implantation (TAVI) between May 2016 and September 2016
After the exclusion of two patients who died early after the procedure and one case of severe aortic regurgitation, an additional 34 cases were included in the study—resulting in a final study sample of
The improved hemodynamic performances observed with TAVI were unexpected because this procedure requires the crushing of the native severely calcified valve by the stented prosthesis—a mechanism which may be characterized by obstructive elements per se

Summary

Introduction

Surgical aortic valve replacement remains the definitive treatment for severe symptomatic AS. Transcatheter aortic valve implantation (TAVI) has emerged as the procedure of choice for patients who face a high risk of complications after surgery (e.g., in presence of advanced age or multiple comorbidities) [2]. First-generation percutaneous prostheses are capable of preventing patient–prosthesis mismatch (PPM) and are characterized by superior hemodynamic performances in terms of transprosthetic gradient—albeit at the expense of an increased aortic regurgitation [3]. The effective orifice area (EOA) measured by Doppler echocardiography is generally dependent on the prosthesis size, regardless of its positioning with either surgery [4] or TAVI [5]

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