Thorac Cardiovasc Surg 2013; 61 - OP18
DOI: 10.1055/s-0032-1332257

Aortic regurgitation after TAVI using first and second-generation transcatheter heart valves

M Seiffert 1, P Diemert 2, L Conradi 1, AC Terstesse 1, J Schirmer 1, D Koschyk 2, R Schnabel 2, S Wilde 2, S Blankenberg 2, H Reichenspurner 1, S Baldus 2, H Treede 1
  • 1Universitäres Herzzentrum Hamburg, Klinik für Herz- und Gefäßchirurgie, Hamburg, Germany
  • 2Universitäres Herzzentrum Hamburg, Klinik für Allgemeine und Interventionelle Kardiologie, Hamburg, Germany

Aims: The adverse impact of paravalvular aortic regurgitation (AR) on survival after transcatheter aortic valve implantation (TAVI) has been documented. Advanced imaging and second-generation transcatheter heart valves aim to decrease the burden of AR after TAVI. We aim to analyse this issue comparing different first- and second-generation devices.

Methods: TAVI was performed in 458 consecutive patients employing the Edwards Sapien (ES, Edwards Lifesciences, Irvine, USA), Medtronic CoreValve (CV, Medtronic, Minneapolis, USA), JenaValve (JV, JenaValve Technology GmbH, Munich, Germany), and Symetis Acurate (SYM, Symetis S.A., Ecublens, Switzerland) devices via transfemoral or transapical approaches. Annulus diameter was assessed preoperatively by transesophageal echocardiography. Paravalvular aortic regurgitation was evaluated echocardiographically at discharge and compared among the groups (Kruskal-Wallis test).

Results: Degree of paravalvular AR differed between the approaches (p = 0.036). Median AR was 1 (interquartile range 0 to 1) in all groups and AR > grade 1 was observed in 15.7% (CV, n = 63), 10.6% (transfemoral ES, n = 133), 7.8% (transapical ES, n = 205), 6.2% (SYM, n = 19), and 2.9% (JV, n = 38) of patients after TAVI. At the same time, oversizing of transcatheter heart valves in relation to the native aortic annulus was 14.4 ± 5.3% (CV), 11.2 ± 6.0% (transfemoral ES), 10.4 ± 6.0% (transapical ES), 7.1 ± 4.4% (SYM), and 5.9 ± 4.8% (JV), respectively (p < 0.001).

Conclusion: The incidence of relevant paravalvular AR was lower after transapical TAVI compared to the transfemoral approach. The number of patients receiving the self-expanding CV left with notable AR was largest, as was the extent of oversizing in this group. It declined with the transapical approach and second-generation devices, potentially decreasing the risk for annular rupture. Notwithstanding deviating group sizes, this first report allows comparison of currently available transcatheter heart valves with regard to AR and particularly promising results for second-generation devices.