Impact of Annular Size on Outcomes After Surgical or Transcatheter Aortic Valve Replacement.

Authors

• G Michael Deeb
• Stanley J Chetcuti
• Steven J Yakubov, OhioHealth
• Himanshu J Patel
• P Michael Grossman
• Neal S Kleiman
• John Heiser
• William Merhi
• George L Zorn
• Peter N Tadros
• George Petrossian
• Newell Robinson
• Mubashir Mumtaz
• Thomas G Gleason
• Jian Huang
• John V Conte
• Jeffrey J Popma
• Michael J Reardon

Document Type

Article

Publication Title

The Annals of thoracic surgery

Abstract

BACKGROUND: This analysis evaluates the relationship of annular size to hemodynamics and the incidence of prosthesis-patient mismatch (PPM) in surgical aortic valve replacement (SAVR) and transcatheter aortic valve replacement (TAVR) patients.

METHODS: The CoreValve US Pivotal High Risk Trial, described previously, compared TAVR using a self-expanding valve with SAVR. Multislice computed tomography was used to categorize TAVR and SAVR subjects according to annular perimeter-derived diameter: large (≥26 mm), medium (23 to < 26 mm), and small (< 23 mm). Hemodynamics, PPM, and clinical outcomes were assessed.

RESULTS: At all postprocedure visits, mean gradients were significantly lower for TAVR compared with SAVR in small and medium size annuli (p < 0.001). Annular size was significantly associated with mean gradient after SAVR, with small annuli having the highest gradients (p < 0.05 at all timepoints); gradients were similar across all annular sizes after TAVR. In subjects receiving SAVR, the frequency of PPM was significantly associated with annular size, with small annuli having the greatest incidence. No difference in PPM incidence by annular sizing was observed with TAVR. In addition, TAVR subjects had significantly less PPM than SAVR subjects in small and medium annuli (p < 0.001), with no difference in the incidence of PPM between TAVR and SAVR in large annuli (p = 0.10).

CONCLUSIONS: Annular size has a significant effect on hemodynamics and the incidence of PPM in SAVR subjects, not observed in TAVR subjects. With respect to annular size, TAVR results in better hemodynamics and less PPM for annuli less than 26 mm and should be strongly considered when choosing a tissue valve for small and medium size annuli.

First Page

1129

Last Page

1136

DOI

10.1016/j.athoracsur.2017.08.059

Publication Date

4-1-2018

Recommended Citation

Deeb GM, Chetcuti SJ, Yakubov SJ, Patel HJ, Grossman PM, Kleiman NS, Heiser J, Merhi W, Zorn GL 3rd, Tadros PN, Petrossian G, Robinson N, Mumtaz M, Gleason TG, Huang J, Conte JV, Popma JJ, Reardon MJ. Impact of Annular Size on Outcomes After Surgical or Transcatheter Aortic Valve Replacement. Ann Thorac Surg. 2018 Apr;105(4):1129-1136. doi: 10.1016/j.athoracsur.2017.08.059. Epub 2018 Jan 5. PMID: 29307456.