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Comparison of Transcatheter Aortic Valve Replacement between Self-Expanding versus Balloon-Expandable Valves in Patients with Small Aortic Annulus
- Source :
- Korean Circulation Journal
- Publication Year :
- 2020
-
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 ≤23 mm or minimal diameter ≤21 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±0.28 vs. 1.75±0.42 cm², p=0.002) and indexed EOA (0.95±0.21 vs. 1.18±0.28 cm²/m², p=0.001), whereas mean aortic valve gradient (11.7±2.9 vs. 8.9±5.2 mmHg, P=0.005) and incidence of ≥moderate 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.
- Subjects :
- medicine.medical_specialty
business.industry
medicine.medical_treatment
Acute kidney injury
Hemodynamics
Aortic valve stenosis
medicine.disease
Transcatheter aortic valve replacement
Stenosis
Aortic valve replacement
Valve replacement
Internal medicine
Internal Medicine
medicine
Cardiology
cardiovascular system
Cardiac skeleton
Cardiology and Cardiovascular Medicine
business
Stroke
Original Research
Subjects
Details
- ISSN :
- 17385520
- Volume :
- 51
- Issue :
- 3
- Database :
- OpenAIRE
- Journal :
- Korean circulation journal
- Accession number :
- edsair.doi.dedup.....9cdfbbd34989689fd7b1ad6721de1d96