Hemodynamic Effects of Valve Asymmetry in Sapien 3 Transcatheter Aortic Valves. J Invasive Cardiol 2018 Apr;30(4):138-143
Date
04/04/2018Pubmed ID
29610444Scopus ID
2-s2.0-85044958259 (requires institutional sign-in at Scopus site) 8 CitationsAbstract
BACKGROUND: Eccentric valve deployment after transcatheter aortic valve replacement (TAVR) has been associated with abnormal leaflet shear stresses that may accelerate structural valve deterioration (SVD). This phenomenon has not been studied in patients receiving Sapien 3 prostheses (Edwards Lifesciences).
METHODS: A retrospective cohort analysis of 100 patients who received Sapien 3 valves between 2013 and 2015 at a single institution was performed. Axial fluoroscopic images from the co-planar view were used to assess TAVR asymmetry, which was defined as a ratio of left-to-right valve heights ≤0.9 or ≥1.1. Transthoracic echocardiograms (TTEs) were obtained at follow-up to analyze peak and mean aortic valve (AV) gradients, paravalvular leak (PVL), and aortic insufficiency (AI).
RESULTS: Overall, 26 mm and 29 mm valves had greater asymmetry (45.2% and 46.9%) compared to 23 mm valves (21.2%; P=.06). There was no relationship between pre-TAVR eccentricity and post-TAVR asymmetry, but greater annular calcification was associated with a higher incidence of TAVR asymmetry. Although asymmetry was associated with higher mean and peak AV gradients among 23 mm and 26 mm valves at both 1-year and 2-year follow-up exams, these results did not reach significance. There were no significant differences in PVL or AI severity between asymmetric and symmetric valves.
CONCLUSIONS: Asymmetric deployment of Sapien 3 valves is common, particularly among 26 mm and 29 mm prostheses. Overall, we detected a small increase in gradients in smaller prostheses, which could reflect early subclinical SVD. Longer follow-up will be necessary to determine the extent to which eccentricity is associated with clinically significant SVD.
Author List
Mangels DR, Siki M, Menon R, Bavaria J, Anwaruddin S, Giri J, Desai N, Szeto WY, Vallabhajosyula P, Herrmann HCAuthor
Saif Anwaruddin MD Associate Professor in the Medicine department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AgedAged, 80 and over
Aortic Valve
Aortic Valve Stenosis
Female
Fluoroscopy
Follow-Up Studies
Heart Valve Prosthesis
Hemodynamics
Humans
Male
Prosthesis Design
Retrospective Studies
Tomography, X-Ray Computed
Transcatheter Aortic Valve Replacement