TY - JOUR
T1 - Valve Performance Between Latest-Generation Balloon-Expandable and Self-Expandable Transcatheter Heart Valves in a Small Aortic Annulus
AU - OCEAN-TAVI Investigators
AU - Hioki, Hirofumi
AU - Yamamoto, Masanori
AU - Shirai, Shinichi
AU - Ohno, Yohei
AU - Yashima, Fumiaki
AU - Naganuma, Toru
AU - Yamawaki, Masahiro
AU - Watanabe, Yusuke
AU - Yamanaka, Futoshi
AU - Mizutani, Kazuki
AU - Ryuzaki, Toshinobu
AU - Noguchi, Masahiko
AU - Izumo, Masaki
AU - Takagi, Kensuke
AU - Asami, Masahiko
AU - Ueno, Hiroshi
AU - Nishina, Hidetaka
AU - Otsuka, Toshiaki
AU - Suzuyama, Hiroto
AU - Yamasaki, Kazumasa
AU - Nishioka, Kenji
AU - Hachinohe, Daisuke
AU - Fuku, Yasushi
AU - Hayashida, Kentaro
N1 - Publisher Copyright:
© 2024 American College of Cardiology Foundation
PY - 2024/11/25
Y1 - 2024/11/25
N2 - Background: Transcatheter aortic valve replacement (TAVR) using a self-expandable valve (SEV) promotes better hemodynamics compared with a balloon-expandable valve (BEV) in a small aortic annulus (SAA). Objectives: The authors sought to compare hemodynamic properties and clinical outcomes between the latest-generation BEV and SEV after TAVR for SAA. Methods: We retrospectively analyzed 1,227 patients undergoing TAVR for aortic stenosis with SAA, defined as an annulus area ≤430 mm2, using the BEV (SAPIEN3 Ultra RESILIA, Edwards Lifesciences) and SEV (Evolut FX, Medtronic). The impact of valve design on severe prosthesis–patient mismatch, aortic valve mean pressure gradient ≥20 mm Hg, paravalvular leakage (PVL) ≥ mild, new permanent pacemaker implantation (PMI), and modified VARC-3 device success at discharge was evaluated using logistic regression and propensity score analysis. Results: Of 1,227 patients, 798 (65.0%) underwent TAVR with BEV implantation. TAVR using BEV had a relatively higher rate of severe prosthesis–patient mismatch (OR: 1.74; 95% CI: 0.54-5.62) and significantly higher incidence of mean pressure gradient ≥20 mm Hg (OR: 2.05; 95% CI: 0.91-4.62) than that using SEV. By contrast, the BEV showed significantly lower incidence of PVL ≥ mild (OR: 0.19; 95% CI: 0.14-0.26), and new PMI (OR: 0.53; 95% CI: 0.33-0.86). The rate of device success was comparable between the BEV and the SEV. These results were confirmed by propensity score analysis. Conclusions: In TAVR for SAA, SEV demonstrated better hemodynamics than the latest BEV, whereas the latest BEV had lower incidences of PVL ≥ mild and new PMI than the SEV.
AB - Background: Transcatheter aortic valve replacement (TAVR) using a self-expandable valve (SEV) promotes better hemodynamics compared with a balloon-expandable valve (BEV) in a small aortic annulus (SAA). Objectives: The authors sought to compare hemodynamic properties and clinical outcomes between the latest-generation BEV and SEV after TAVR for SAA. Methods: We retrospectively analyzed 1,227 patients undergoing TAVR for aortic stenosis with SAA, defined as an annulus area ≤430 mm2, using the BEV (SAPIEN3 Ultra RESILIA, Edwards Lifesciences) and SEV (Evolut FX, Medtronic). The impact of valve design on severe prosthesis–patient mismatch, aortic valve mean pressure gradient ≥20 mm Hg, paravalvular leakage (PVL) ≥ mild, new permanent pacemaker implantation (PMI), and modified VARC-3 device success at discharge was evaluated using logistic regression and propensity score analysis. Results: Of 1,227 patients, 798 (65.0%) underwent TAVR with BEV implantation. TAVR using BEV had a relatively higher rate of severe prosthesis–patient mismatch (OR: 1.74; 95% CI: 0.54-5.62) and significantly higher incidence of mean pressure gradient ≥20 mm Hg (OR: 2.05; 95% CI: 0.91-4.62) than that using SEV. By contrast, the BEV showed significantly lower incidence of PVL ≥ mild (OR: 0.19; 95% CI: 0.14-0.26), and new PMI (OR: 0.53; 95% CI: 0.33-0.86). The rate of device success was comparable between the BEV and the SEV. These results were confirmed by propensity score analysis. Conclusions: In TAVR for SAA, SEV demonstrated better hemodynamics than the latest BEV, whereas the latest BEV had lower incidences of PVL ≥ mild and new PMI than the SEV.
KW - balloon-expandable valve
KW - self-expandable valve
KW - small aortic annulus
KW - transcatheter aortic valve replacement
KW - valve performance
UR - http://www.scopus.com/inward/record.url?scp=85209249269&partnerID=8YFLogxK
U2 - 10.1016/j.jcin.2024.08.049
DO - 10.1016/j.jcin.2024.08.049
M3 - 学術論文
C2 - 39603775
AN - SCOPUS:85209249269
SN - 1936-8798
VL - 17
SP - 2612
EP - 2622
JO - JACC: Cardiovascular Interventions
JF - JACC: Cardiovascular Interventions
IS - 22
ER -