Impact of small prosthesis size on transcatheter or surgical aortic valve replacement outcomes

Impact of small prosthesis size on transcatheter or surgical aortic valve replacement outcomes INTRODUCTIONAortic stenosis (AS) remains the most common valvular heart disease of older adults, affecting over 3% of the elderly population . Surgical aortic valve replacement (SAVR) has long been the standard of care for symptomatic AS yet 30–40% of patients are deemed too high risk for surgical intervention . Since the PARTNER trial, transcatheter aortic valve replacement (TAVR) has emerged as an alternative to SAVR in patients considered inoperable or too high risk due to advanced age and comorbidities . More recently, the PARTNER II trial demonstrated comparable efficacy in intermediate risk patients (STS score < 8) . Studies from the PARTNER trial have also shown that aortic annulus size had a major impact on valve hemodynamics and clinical outcomes after TAVR and SAVR with larger annuli in TAVR associated with a greater incidence of moderate/severe paravalvular regurgitation but lower rates of severe prosthesis‐patient mismatch (PPM) .PPM, an inadequately sized effective orifice area of an implanted prosthesis relative to patient body size, can result in high transprosthesis gradients, resulting in greater left ventricular effort, a subsequent reduction in left ventricular mass regression, and ultimately reduced survival . SAVR in patients with severe AS who have small aortic annuli has been associated http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Catheterization and Cardiovascular Interventions Wiley

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Publisher
Wiley
Copyright
© 2018 Wiley Periodicals, Inc.
ISSN
1522-1946
eISSN
1522-726X
D.O.I.
10.1002/ccd.27120
Publisher site
See Article on Publisher Site

Abstract

INTRODUCTIONAortic stenosis (AS) remains the most common valvular heart disease of older adults, affecting over 3% of the elderly population . Surgical aortic valve replacement (SAVR) has long been the standard of care for symptomatic AS yet 30–40% of patients are deemed too high risk for surgical intervention . Since the PARTNER trial, transcatheter aortic valve replacement (TAVR) has emerged as an alternative to SAVR in patients considered inoperable or too high risk due to advanced age and comorbidities . More recently, the PARTNER II trial demonstrated comparable efficacy in intermediate risk patients (STS score < 8) . Studies from the PARTNER trial have also shown that aortic annulus size had a major impact on valve hemodynamics and clinical outcomes after TAVR and SAVR with larger annuli in TAVR associated with a greater incidence of moderate/severe paravalvular regurgitation but lower rates of severe prosthesis‐patient mismatch (PPM) .PPM, an inadequately sized effective orifice area of an implanted prosthesis relative to patient body size, can result in high transprosthesis gradients, resulting in greater left ventricular effort, a subsequent reduction in left ventricular mass regression, and ultimately reduced survival . SAVR in patients with severe AS who have small aortic annuli has been associated

Journal

Catheterization and Cardiovascular InterventionsWiley

Published: Jan 1, 2018

Keywords: ; ; ;

References

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