Comparison of Transcatheter Aortic Valve Replacement between Self-Expanding versus Balloon-Expandable Valves in Patients with Small Aortic Annulus

Yong Joon Lee, Seung Jun Lee, Sung Jin Hong, ChiYoung Shim, Chul Min Ahn, Jung Sun Kim, Byeong Keuk Kim, Geu Ru Hong, Young Guk Ko, Donghoon Choi, Yangsoo Jang, Myeong Ki Hong

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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.

Original languageEnglish
Article numbere17
JournalKorean Circulation Journal
Volume51
Issue number3
DOIs
Publication statusPublished - 2021 Mar

Bibliographical note

Funding Information:
This work was supported by grants from the Korea Health Technology Research & Development Project through the Korea Health Industry Development Institute, funded by the Ministry of Health & Welfare, Republic of Korea (No. HI17C0882, HI16C2211, and HI15C2782), the Bio & Medical Technology Development Program of the National Research Foundation funded by the Korean government (No. 2015M3A9C6031514), and the Cardiovascular Research Center, Seoul, Korea.

Publisher Copyright:
Copyright © 2021. The Korean Society of Cardiology

All Science Journal Classification (ASJC) codes

  • Internal Medicine
  • Cardiology and Cardiovascular Medicine

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