We have located links that may give you full text access.
Hemodynamic Effects of Valve Asymmetry in Sapien 3 Transcatheter Aortic Valves.
Journal of Invasive Cardiology 2018 April
BACKGROUND: Eccentric valve deployment after transcatheter aortic valve replacement (TAVR) has been associated with abnormal leaflet shear stresses that may accelerate structural valve deterioration (SVD). This phenomenon has not been studied in patients receiving Sapien 3 prostheses (Edwards Lifesciences).
METHODS: A retrospective cohort analysis of 100 patients who received Sapien 3 valves between 2013 and 2015 at a single institution was performed. Axial fluoroscopic images from the co-planar view were used to assess TAVR asymmetry, which was defined as a ratio of left-to-right valve heights ≤0.9 or ≥1.1. Transthoracic echocardiograms (TTEs) were obtained at follow-up to analyze peak and mean aortic valve (AV) gradients, paravalvular leak (PVL), and aortic insufficiency (AI).
RESULTS: Overall, 26 mm and 29 mm valves had greater asymmetry (45.2% and 46.9%) compared to 23 mm valves (21.2%; P=.06). There was no relationship between pre-TAVR eccentricity and post-TAVR asymmetry, but greater annular calcification was associated with a higher incidence of TAVR asymmetry. Although asymmetry was associated with higher mean and peak AV gradients among 23 mm and 26 mm valves at both 1-year and 2-year follow-up exams, these results did not reach significance. There were no significant differences in PVL or AI severity between asymmetric and symmetric valves.
CONCLUSIONS: Asymmetric deployment of Sapien 3 valves is common, particularly among 26 mm and 29 mm prostheses. Overall, we detected a small increase in gradients in smaller prostheses, which could reflect early subclinical SVD. Longer follow-up will be necessary to determine the extent to which eccentricity is associated with clinically significant SVD.
METHODS: A retrospective cohort analysis of 100 patients who received Sapien 3 valves between 2013 and 2015 at a single institution was performed. Axial fluoroscopic images from the co-planar view were used to assess TAVR asymmetry, which was defined as a ratio of left-to-right valve heights ≤0.9 or ≥1.1. Transthoracic echocardiograms (TTEs) were obtained at follow-up to analyze peak and mean aortic valve (AV) gradients, paravalvular leak (PVL), and aortic insufficiency (AI).
RESULTS: Overall, 26 mm and 29 mm valves had greater asymmetry (45.2% and 46.9%) compared to 23 mm valves (21.2%; P=.06). There was no relationship between pre-TAVR eccentricity and post-TAVR asymmetry, but greater annular calcification was associated with a higher incidence of TAVR asymmetry. Although asymmetry was associated with higher mean and peak AV gradients among 23 mm and 26 mm valves at both 1-year and 2-year follow-up exams, these results did not reach significance. There were no significant differences in PVL or AI severity between asymmetric and symmetric valves.
CONCLUSIONS: Asymmetric deployment of Sapien 3 valves is common, particularly among 26 mm and 29 mm prostheses. Overall, we detected a small increase in gradients in smaller prostheses, which could reflect early subclinical SVD. Longer follow-up will be necessary to determine the extent to which eccentricity is associated with clinically significant SVD.
Full text links
Related Resources
Get seemless 1-tap access through your institution/university
For the best experience, use the Read mobile app
All material on this website is protected by copyright, Copyright © 1994-2024 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.
By using this service, you agree to our terms of use and privacy policy.
Your Privacy Choices
You can now claim free CME credits for this literature searchClaim now
Get seemless 1-tap access through your institution/university
For the best experience, use the Read mobile app