Impact of Aortic Root Anatomy and Geometry on Paravalvular Leak in Transcatheter Aortic Valve Replacement With Extremely Large Annuli Using the Edwards SAPIEN 3 Valve.
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Tang Gilbert H L, Zaid Syed, George Isaac, Khalique Omar K, Abramowitz Yigal, Maeno Yoshio, Makkar Raj R, Jilaihawi Hasan, Kamioka Norihiko, Thourani Vinod H, Babaliaros Vasilis, Webb John G, Htun Nay M, Attinger-Toller Adrian, Ahmad Hasan, Kaple Ryan, Sharma Kapil, Kozina Joseph A, Kaneko Tsuyoshi, Shah Pinak, Hirji Sameer A, Desai Nimesh D, Anwaruddin Saif, Jagasia Dinesh, Herrmann Howard C, Basra Sukhdeep S, Szerlip Molly A, Mack Michael J, Mathur Moses, Tan Christina W, Don Creighton W, Sharma Rahul, Gafoor Sameer, Zhang Ming, Kapadia Samir R, Mick Stephanie L, Krishnaswamy Amar, Amoroso Nicholas, Salemi Arash, Wong S Chiu, Kini Annapoorna S, Rodés-Cabau Josep, Leon Martin B, Kodali Susheel K
Аннотация
BACKGROUND: The largest recommended annular area for the 29-mm S3 is 683 mm2. However, experience with S3 TAVR in annuli >683 mm2 has not been widely reported.
METHODS: From December 2013 to July 2017, 74 patients across 16 centers with mean area 721 ± 38 mm2 (range: 684 to 852 mm2) underwent S3 TAVR. The transfemoral approach was used in 95%, and 39% were under conscious sedation. Patient, anatomic, and procedural characteristics were retrospectively analyzed. Valve Academic Research Consortium-2 outcomes were reported.
RESULTS: Procedural success was 100%, with 2 deaths, 1 stroke, and 2 major vascular complications at 30 days. Post-dilatation occurred in 32%, with final balloon overfilling (1 to 5 ml extra) in 70% of patients. Implantation depth averaged 22.3 ± 12.4% at the noncoronary cusp and 20.7 ± 9.9% at the left coronary cusp. New left bundle branch block occurred in 17%, and 6.3% required new permanent pacemakers. Thirty-day echocardiography showed mild PVL in 22.3%, 6.9% moderate, and none severe. There was no annular rupture or coronary obstruction. Mild or greater PVL was associated with larger maximum annular and left ventricular outflow tract (LVOT) diameters, larger LVOT area and perimeter, LVOT area greater than annular area, and higher annular eccentricity.
CONCLUSIONS: TAVR with the 29-mm S3 valve beyond the recommended range by overexpansion is safe, with acceptable PVL and pacemaker rates. Larger LVOTs and more eccentric annuli were associated with more PVL. Longer term follow-up will be needed to determine durability of S3 TAVR in this population.