TY - JOUR
T1 - Impact of Annular Size on Outcomes After Surgical or Transcatheter Aortic Valve Replacement
AU - Deeb, G. Michael
AU - Chetcuti, Stanley J.
AU - Yakubov, Steven J.
AU - Patel, Himanshu J.
AU - Grossman, P. Michael
AU - Kleiman, Neal S.
AU - Heiser, John
AU - Merhi, William
AU - Zorn, George L.
AU - Tadros, Peter N.
AU - Petrossian, George
AU - Robinson, Newell
AU - Mumtaz, Mubashir
AU - Gleason, Thomas G.
AU - Huang, Jian
AU - Conte, John V.
AU - Popma, Jeffrey J.
AU - Reardon, Michael J.
N1 - Funding Information:
Jessica Dries-Devlin, PhD, of Medtronic prepared tables and figures, provided copy-editing support, and ensured technical accuracy of the manuscript. Mike Boulware, PhD, of Medtronic, provided expert review of the article. The study was funded by Medtronic (Minneapolis, MN). Dr Deeb serves on an advisory board and as a proctor for Medtronic; as a consultant and research investigator for Edwards Lifesciences; as a consultant and proctor for Terumo; and as a research investigator for Gore Medical. Dr Chetcuti has received grant support from Edwards Lifesciences, Boston Scientific, and Medtronic. Dr Yakubov has received grant support and served on advisory boards for Medtronic and Boston Scientific, and has received grant support from Direct Flow Medical. Dr Grossman has received grant support from Edwards Lifesciences, Medtronic, and Boston Scientific. Dr Kleiman receives institutional fees from Medtronic for providing educational services. Dr Tadros has received research support from Medtronic and St. Jude Medical. Dr Mumtaz has received research support from Atricure, Millipede, Abbott Vascular, JOMDD, Edwards Lifesciences, and Medtronic. Dr. Gleason receives grant support from Medtronic. Dr Conte has received grant support from and serves on a surgical advisory board for Medtronic and Sorin. Dr Popma has received grants from Medtronic, Boston Scientific, and Direct Flow Medical. Dr Reardon receives institutional grants from and serves on an advisory board for Medtronic.
Publisher Copyright:
© 2018 The Society of Thoracic Surgeons
PY - 2018/4
Y1 - 2018/4
N2 - 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.
AB - 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.
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U2 - 10.1016/j.athoracsur.2017.08.059
DO - 10.1016/j.athoracsur.2017.08.059
M3 - Article
C2 - 29307456
AN - SCOPUS:85039937643
SN - 0003-4975
VL - 105
SP - 1129
EP - 1136
JO - Annals of Thoracic Surgery
JF - Annals of Thoracic Surgery
IS - 4
ER -