Comparison of Transcatheter Aortic Valve Replacement between Self-Expanding versus Balloon-Expandable Valves in Patients with Small Aortic Annulus
Korean Circulation Journal 2021³â 51±Ç 3È£ p.222 ~ p.231
ÀÌ¿ëÁØ(Lee Yong-Joon) - Yonsei University Health System Severance Cardiovascular Hospital Division of Cardiology
À̽ÂÁØ(Lee Seung-Jun) - Yonsei University Health System Severance Cardiovascular Hospital Division of Cardiology
È«¼ºÁø(Hong Sung-Jin) - Yonsei University Health System Severance Cardiovascular Hospital Division of Cardiology
½ÉÁö¿µ(Shim Chi-Young) - Yonsei University Health System Severance Cardiovascular Hospital Division of Cardiology
¾Èö¹Î(Ahn Chul-Min) - Yonsei University Health System Severance Cardiovascular Hospital Division of Cardiology
±èÁß¼±(Kim Jung-Sun) - Yonsei University Health System Severance Cardiovascular Hospital Division of Cardiology
±èº´±Ø(Kim Byeong-Keuk) - Yonsei University Health System Severance Cardiovascular Hospital Division of Cardiology
È«±×·ç(Hong Geu-Ru) - Yonsei University Health System Severance Cardiovascular Hospital Division of Cardiology
°í¿µ±¹(Ko Young-Guk) - Yonsei University Health System Severance Cardiovascular Hospital Division of Cardiology
ÃÖµ¿ÈÆ(Choi Dong-Hoon) - Yonsei University Health System Severance Cardiovascular Hospital Division of Cardiology
Àå¾ç¼ö(Jang Yang-Soo) - Yonsei University Health System Severance Cardiovascular Hospital Division of Cardiology
È«¸í±â(Hong Myeong-Ki) - Yonsei University Health System Severance Cardiovascular Hospital Division of Cardiology
Abstract
Background and Objectives: Transcatheter aortic valve replacement (TAVR) has been reported as a good alternative for surgical aortic valve replacement in patients with small aortic annulus. Head-to-head comparisons of different transcatheter aortic valves in these patients are insufficient. We compared the outcomes after TAVR between two different types of recent transcatheter aortic valves (self-expanding vs. balloon-expandable) in patients with small aortic annulus.
Methods: A total of 70 patients with severe aortic stenosis and small annulus (mean diameter ¡Â23 mm or minimal diameter ¡Â21 mm on computed tomography) underwent TAVR with either a self-expanding valve with supra-annular location (n=45) or a balloon-expandable valve with intra-annular location (n=25). The echocardiographic hemodynamic parameters after TAVR and 1-year follow-up were compared.
Results: Between the self-expanding and balloon-expandable valve-treated patients, the clinical outcomes including permanent pacemaker implantation (11.1% vs. 8.0%), acute kidney injury stage 2 or 3 (4.4% vs. 4.0%), and major vascular complication (4.4% vs. 0.0%) were similar without all-cause mortality, stroke, and life-threatening bleeding during 30-day follow-up. Compared with the balloon-expandable valve-treated patients, the self-expanding valve-treated patients presented larger effective orifice area (EOA) (1.46¡¾0.28 vs. 1.75¡¾0.42 cm2, p=0.002) and indexed EOA (0.95¡¾0.21 vs. 1.18¡¾0.28 cm2/m2, p=0.001), whereas mean aortic valve gradient (11.7¡¾2.9 vs. 8.9¡¾5.2 mmHg, P=0.005) and incidence of ¡Ãmoderate prosthesis-patient mismatch (36.0% vs. 8.9%, p=0.009) were lower. These hemodynamic differences were maintained at 1-year follow-up.
Conclusions: TAVR with self-expanding valves was associated with superior hemodynamic outcomes compared with balloon-expandable valves in patients with small aortic annulus.
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Transcatheter aortic valve replacement, Aortic valve stenosis
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TAVR with self-expanding valves was associated with superior hemodynamic outcomes compared with balloon-expandable valves in patients with small aortic annulus.