Clinical outcomes of transcatheter aortic valve implantation in patients with extremely large annulus and SAPIEN 3 dimensions based on post-procedural computed tomography

TY - JOUR

T1 - Clinical outcomes of transcatheter aortic valve implantation in patients with extremely large annulus and SAPIEN 3 dimensions based on post-procedural computed tomography

AU - Miyasaka, Masaki

AU - Yoon, Sung Han

AU - Sharma, Rahul P.

AU - Maeno, Yoshio

AU - Jaideep, Sandhu

AU - Taguri, Masataka

AU - Kato, Shigeaki

AU - Kawamori, Hiroyuki

AU - Nomura, Takahiro

AU - Ochiai, Tomoki

AU - Nemanpour, Shadi

AU - Chakravarty, Tarun

AU - Nakamura, Mamoo

AU - Wen, Cheng

AU - Makkar, Raj

N1 - Publisher Copyright: © 2019, Japanese Circulation Society. All rights reserved.

PY - 2019/2/25

Y1 - 2019/2/25

N2 - Background: Patients with severe aortic stenosis (AS) and an extra-large annulus (ELA) area (>683 mm 2 ) can rarely be treated by transcatheter aortic valve replacement (TAVR) because of the size limitation of the transcatheter heart valves. This study aimed to evaluate the feasibility of TAVR using a 29-mm SAPIEN3 (S3) valve in patients with ELA and S3-dimensions by post-procedural computed tomography (post-CT). Methods and Results: We included 261 patients undergoing TAVR using a 29-mm S3: 30 patients with ELA and 231 with non-ELA were identified. S3-dimensions were evaluated at the S3 inflow and annulus level by post-CT in 129 patients. The ELA group had a greater aortic annulus area measured by pre-procedural CT (737.3±54.7 vs. 578.4±41.9 mm 2 , P<0.0001), higher balloon inflation volume (36 vs. 33mL, P<0.0001), a larger S3 area at inflow by post-CT (729.6±42.2 vs. 682.2±35.0 mm 2 , P<0.001), and a correlation between the inflation volume and S3 area (r=0.71, P=0.0005). No differences were observed between groups in paravalvular aortic regurgitation (PAR) ≥mild (43.3% vs. 27.6%, P=0.09), PAR ≥moderate (3.3% vs. 1.3%, P=0.39) or 1-year mortality (10.0% vs. 9.1%, P=0.87). Conclusions: TAVR using a 29-mm S3 with extra inflation of the delivery balloon can be considered as a treatment option for patients with severe AS and ELA.

AB - Background: Patients with severe aortic stenosis (AS) and an extra-large annulus (ELA) area (>683 mm 2 ) can rarely be treated by transcatheter aortic valve replacement (TAVR) because of the size limitation of the transcatheter heart valves. This study aimed to evaluate the feasibility of TAVR using a 29-mm SAPIEN3 (S3) valve in patients with ELA and S3-dimensions by post-procedural computed tomography (post-CT). Methods and Results: We included 261 patients undergoing TAVR using a 29-mm S3: 30 patients with ELA and 231 with non-ELA were identified. S3-dimensions were evaluated at the S3 inflow and annulus level by post-CT in 129 patients. The ELA group had a greater aortic annulus area measured by pre-procedural CT (737.3±54.7 vs. 578.4±41.9 mm 2 , P<0.0001), higher balloon inflation volume (36 vs. 33mL, P<0.0001), a larger S3 area at inflow by post-CT (729.6±42.2 vs. 682.2±35.0 mm 2 , P<0.001), and a correlation between the inflation volume and S3 area (r=0.71, P=0.0005). No differences were observed between groups in paravalvular aortic regurgitation (PAR) ≥mild (43.3% vs. 27.6%, P=0.09), PAR ≥moderate (3.3% vs. 1.3%, P=0.39) or 1-year mortality (10.0% vs. 9.1%, P=0.87). Conclusions: TAVR using a 29-mm S3 with extra inflation of the delivery balloon can be considered as a treatment option for patients with severe AS and ELA.

KW - Computed tomography (CT)

KW - Inflation volume

KW - Large aortic annulus

KW - Transcatheter aortic valve replacement (TAVR)

UR - https://www.scopus.com/pages/publications/85062098485

U2 - 10.1253/circj.CJ-18-1059

DO - 10.1253/circj.CJ-18-1059

M3 - Article

C2 - 30700661

SN - 1346-9843

VL - 83

SP - 672

EP - 680

JO - Circulation Journal

JF - Circulation Journal

IS - 3

ER -