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 |
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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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