Left Ventricular Hypertrophy Regression Following Transcatheter Aortic Replacement: A Comparison of Self-Expanding Versus Balloon-Expandable Prostheses

Abstract

There are limited reports on the impact of prosthesis-patient mismatch (PPM) on regression of left ventricular hypertrophy (LVH) following transcatheter aortic valve replacement (TAVR). We compared the relative effects of supra-annular, self-expanding (SE) versus intra-annular, balloon-expandable (BE) prostheses on TAVR LVH regression. Regression of left ventricular mass index (LVMi) was evaluated in 168 consecutive TAVR patients, including 60 treated with SE valves (Evolut series) and 108 treated with BE valves (Sapien 3). All patients had LVH determined at baseline by echocardiography and had repeat LVMi measurements at a mean follow-up time of 707±528 days. SE patients were more likely female (68.3 vs 46.3%, p=0.007), but otherwise the two cohorts did not differ with respect to baseline demographics and STS Risk Score. SE patients had a higher effective orifice area indexed to body surface area (EOAi) following TAVR (0.98±0.29 vs 0.86±0.25 cm²/m², p=0.006), with lower mean aortic valve gradients (9.9±6.5 vs 12.8±5.8 mmHg, p=0.003) and a lower prevalence of moderate/severe PPM (33.3 vs. 49.1%, p=0.049). On follow-up, changes in LVMi were similar between the SE and BE groups, with similar absolute changes in LVMi (19.2±26.8 vs. 21.9±31.7 g/m2, p=0.578) and relative LVMi decrease (14.0±19.5 vs 16.2±24.2%, p=0.547). No difference in LVMi regression was also noted comparing combined SE/BE patients with moderate/severe PPM versus those without PPM. In conclusion, despite differences in EOAi, mean aortic valve gradient, and prosthesis-patient mismatch post TAVR, the degree of LVH regression during intermediate follow-up did not differ between patients receiving supra-annular SE and intra-annular BE prostheses.