In low-risk patients, there was a very low incidence of greater than moderate leak, including in patients with minimal oversizing.
The degree of prosthesis oversizing had a great impact on mild paravalvular leak reduction and the need for post-dilation without changing valve hemodynamics.
This research investigated the impact of the perimeter and the area, measured by tomography, and the valve size chosen on the incidence of paravalvular leak in patients treated with a Sapien 3 prosthesis.
The PARTNER (Placement of Aortic Transcatheter Valves 3) study included 495 low surgical risk patients with severe aortic stenosis who underwent transcatheter aortic valve replacement (TAVR). Prosthesis sizing was based on annulus area, as measured by tomography.
Oversizing was 7.9 ± 8.7% for the annulus and 2.1 ± 4.1% for the perimeter. The incidence of leak greater than moderate was very low (0.6%).
The incidence of patients with leak greater than mild who required post-dilation was inversely proportional to the degree of oversizing.
In patients with intermediate measurements—who could therefore receive larger or smaller valves—, larger valves had a lower incidence of leak (12.0% vs. 43.4%; p < 0.0001).
Read also: 3rd Generation Valves in Large and X-Large Annuli.
Prosthesis size (rather than the degree of oversizing) impacted the effective orifice and gradients.
Conclusion
In patients who were candidates to two valvular measures because of their annulus, choosing the larger measure reduces the incidence of leak and improves their hemodynamic profile.
Original Title: Impact of Annular Oversizing on Paravalvular Regurgitation and Valve Hemodynamics: New Insights From PARTNER 3.
Reference: Abdul Rahman Ihdayhid et al. JACC Cardiovasc Inter. 2021 Oct 11;14(19):2158-2169. doi: 10.1016/j.jcin.2021.07.018.
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