Thorac Cardiovasc Surg 2016; 64 - OP229
DOI: 10.1055/s-0036-1571659

Hemodynamic Performance of Self-expandable versus Balloon-expandable Transcatheter Aortic Valve Prosthesis in Patients with a Small Annulus

N. Zugic 1, M. Doss 1, W. Kim 2, H. Baumgarten 1, D. Serio 1, A. Van Linden 1, H. Möllmann 2, C. Hamm 2, T. Walther 1
  • 1Kerckhoff-Klinik GmbH, Herzchirurgie, Bad Nauheim, Germany
  • 2Kerckhoff-Klinik GmbH, Kardiologie, Bad Nauheim, Germany

Objectives: Treatment of aortic stenosis in patients with a small aortic annulus is challenging and patient prosthesis mismatch should be avoided. The aim of this study was to compare the early hemodynamic performance of 23 mm self-expanding (ACURATE S, Symetis Inc.) versus 23 mm balloon-expanding (SAPIEN 3, Edwards Inc.) transcatheter aortic valves.

Methods: A total of 140 patients with small aortic annulus, who were treated between March 2000 and August 2015, were analyzed. Mean effective aortic annulus diameter was 22.1 ± 1.1 mm. 62% (n = 87) of the patients received an ACURATE 23 mm prosthesis and 38% (n = 53) a SAPIEN 3 23 mm prosthesis. Patients were treated using transapical access (n = 71), or a transfemoral access (n = 69). Mean age was identical in both groups (83 ± 6 years) and 92% were female. Discharge echocardiographic data were evaluated, focusing on mean gradient and aortic valve area.

Results: Transthoracic echocardiography revealed a post-operative mean gradient of 13.3 ± 6.7 mm Hg (self-expanding) versus 15 ± 5.2 mm Hg (balloon-expanding), p = 0.12. No differences were observed with regards to post-operative aortic valve area (self-expanding 1.31 ± 0.33 cm2 versus balloon-expanding 1.32 ± 0.6 cm2, p = 0.86). A sub analysis of transapically treated patients did not reveal any significant hemodynamic differences either. Patient prosthesis mismatch was present in 14% (self-expanding) versus 21% (balloon-expanding) of the patients, respectively.

Conclusions: In this retrospective analysis there was no significant difference in the early postprocedural hemodynamic performance between self-expanding versus balloon-expanding transcatheter valve prosthesis in patients with a small aortic annulus. Slightly elevated mean gradients in this patient group may be further improved when using supra-annular prosthesis in the future.