MSCT guided sizing of the Edwards Sapien XT TAVI device: Impact of different degrees of oversizing on clinical outcome
| Autor: | Alexander W. Leber, Ellen Hoffmann, Thomas K. Helmberger, Johannes Rieber, W. Eichinger, Albert M. Kasel, Diethmar Antoni, U. Ebersberger, Gotthard Riess, Jayshree Vogel, M. Deichstetter, M. Lieber, S. Schleger |
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| Rok vydání: | 2013 |
| Předmět: |
Male
medicine.medical_specialty Prosthesis Design Transcatheter Aortic Valve Replacement Prosthesis Fitting Internal medicine medicine Humans In patient Prospective Studies Cardiac skeleton Myocardial infarction Prospective cohort study Stroke Aged 80 and over business.industry Aortic Valve Stenosis medicine.disease Stenosis Cross-Sectional Studies Treatment Outcome Heart Valve Prosthesis Aortic valve stenosis Cardiology Female Tomography X-Ray Computed Cardiology and Cardiovascular Medicine business Echocardiography Transesophageal Edwards sapien |
| Zdroj: | International Journal of Cardiology. 168:2658-2664 |
| ISSN: | 0167-5273 |
| DOI: | 10.1016/j.ijcard.2013.03.030 |
| Popis: | Prospective data on the usage of 3-dimensional imaging based annulus sizing on the outcome of TAVI is not available yet and there is general uncertainty about the optimal degree of oversizing. In the current study we therefore assessed a 3-D MSCT guided over-sizing approach and evaluated the clinical outcome of different degrees of oversizing.TAVI-size-selection was done using systolic MSCT-annulus cross-sectional-area (CSA) measurements in 107 patients with severe aortic stenosis with the goal to oversize the 3rd generation balloon expandable Edwards Sapien XT (ESTV) device in relation to the native aortic annulus CSA.Among different degrees of oversizing there were no differences in the occurrence of stroke, myocardial infarction and death. No aortic injuries were observed. The overall rate ofmild postprocedural aortic regurgitation (PAR) was 7.6%. Increasing oversizing ratios are associated with lower rates ofmild PAR (r = -0.236, p0.02) with the lowest rate ofmild PAR in patients with area based oversizing ratios25% and the highest rate in patients with oversizing ratios15% (0% vs. 15.8%, p0.02). The rate of postprocedural permanent pacemakers tended to be lower in patients with15% oversizing compared to those with25% oversizing (5.3 vs. 16.7%, p0.23).MSCT guided ESTV-device sizing is safe and is associated with significantly lower than previously reported rates for PAR. A device/annulus oversizing ratio of 15-25% based on area and 7-12% based on mean diameter appears to provide the best risk-benefit ratio in terms of PAR reduction and conduction disorders. |
| Databáze: | OpenAIRE |
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