Impact of "high" implantation on functionality of self-expandable bioprosthesis during the short- and long-term outcome of patients who undergo transcatheter aortic valve implantation: Is high implantation beneficial?

Abstract

High position of the self-expandable bioprosthesis CoreValve/Evolut R has been proved to affect immediate hemodynamics of the valve. Whether this may have any impact on long-term procedural outcome has not been defined yet. The purpose of this study was to assess whether the final position of aortic bioprosthesis affects its long-term functionality. Consecutive patients (pts) who underwent successful TAVI procedure were evaluated and separated into 2 groups according to the implantation depth (ID): Group I: pts with 4mm <ID ≤13mm; Group II: pts with ID ≤4mm. ID was measured utilizing the final aortography after device delivery and was defined as the distance both from the native non- and left coronary cusp to the deepest edge of the deployed bioprosthesis in the left ventricle. Clinical outcome and echocardiographic parameters were recorded before the procedure, at discharge, at 1-month and 1-year-follow-up. One hundred and ninety-eight pts (80±5.5years, 107 males [54%]) treated with the CoreValve/Evolut R bioprostheses were recorded. Group I appeared to have higher peak gradient (17±6.5 vs 14±5.5mmHg, P=.02) as well as Vmax (2±0.4 vs 1.84±0.38m/s, P=.02) at follow-up after 1year when compared with Group II (ID <4mm). Grouping for ID did not affect all-cause 1-year mortality. Paravalvular aortic regurgitation, as well as LVEF at discharge, proved to be independent predictors of all-cause 1-year mortality when adjusted for cofactors. Implantation depth under 4mm seems to have a favorable effect on long-term hemodynamic valve functionality.