Undersizing but overfilling eliminates the gray zones of sizing for transcatheter aortic valve replacement with the balloon-expandable bioprosthesis

Autor: Björn Plicht, Dominik Schöne, Kaffer Kara, Peter L. Haldenwang, Polykarpos C. Patsalis, Assem Aweimer, Justus Strauch, Fabian Schiedat, Andreas Mügge, Axel Kloppe, Thomas Buck
Rok vydání: 2020
Předmět:
medicine.medical_specialty
lcsh:Diseases of the circulatory (Cardiovascular) system
Transcatheter aortic
medicine.medical_treatment
THV
transcatheter heart valve
Aortic valve disease
LVEDP
left ventricular end-diastolic pressure
Invasive hemodynamics
030204 cardiovascular system & hematology
Prosthesis
Percutaneous intervention
03 medical and health sciences
0302 clinical medicine
Valve replacement
medicine
PVL
paravalvular leakage
DAP
diastolic aortic pressure
030212 general & internal medicine
Heart valve
LIM principle
Less Is More principle
Original Paper
business.industry
ΔPDAP–LVEDP
pressure gradient between DAP and LVEDP
AR index
aortic regurgitation index
Transcatheter aortic valve replacement
Surgery
Paravalvular leak
BAV
balloon aortic valvuloplasty
Balloon expandable stent
medicine.anatomical_structure
Background current
lcsh:RC666-701
Paravalvular leakage
NF
nominal filling
Cardiology and Cardiovascular Medicine
business
Zdroj: International Journal of Cardiology: Heart & Vasculature, Vol 30, Iss, Pp 100593-(2020)
International Journal of Cardiology. Heart & Vasculature
ISSN: 2352-9067
Popis: Highlights • Transcatheter heart valve size selection is still challenging. • The overlap between two different prosthesis sizes for borderline annuli remains. • Undersizing but overfilling improves sizing in borderline annulus cases. • Undersizing but overfilling decreases the postprocedural THV-pressure gradient. • Prospective studies are needed considering the TAVR expansion to younger patients.
Background Current recommendations for valve size selection are based on multidimensional annular measurements, yet the overlap between two different transcatheter heart valve (THV) sizes remains. We sought to evaluate whether undersizing but overfilling eliminates the gray zones of valve sizing. Methods Data of 246 consecutive patients undergoing transcatheter aortic valve replacement (TAVR) with the balloon-expandable bioprosthesis with either conventional sizing and nominal filling (group 1 (NF-TAVR), n = 154) or undersizing but overfilling under a Less Is More (LIM)-Principle (group 2 (LIM-TAVR), n = 92) were compared. Paravalvular leakage (PVL) was graded angiographically and quantitatively using invasive hemodynamics. Results Annulus rupture (AR) occurred only in group 1 (n = 3). Due to AR adequate evaluation of PVL was possible in 152 patients of group 1. More than mild PVL was found in 13 (8.6%) patients of group 1 and 1 (1.1%) patient of group 2 (p = 0.019). Postdilatation was performed in 31 (20.1%) patients of group 1 and 6 patients (6.5%) of group 2 (p = 0.003). For patients with borderline annulus size in group 1 (n = 35, 22.7%) valve size selection was left to the physiciańs choice resulting in selection of the larger prosthesis in 10 (28.6%). In group 2 all patients with borderline annulus (n = 36, 39.1%) received the smaller prosthesis (LIM-TAVR). The postprocedural mean transvalvular pressure gradient was significantly higher in the NF-TAVR-group (11.7 ± 4 vs. 10.1 ± 3.6 mmHg, p = 0.005). Conclusion LIM-TAVR eliminates the gray zones of sizing and associated PVL, can improve THV-performance, reduce incidence of annular rupture and simplify the procedure especially in borderline cases.
Databáze: OpenAIRE
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