Asymmetry in the Implantation of Self-Expanding Valves in TAVR: Evolution at 5 Years

Severe aortic stenosis is frequently associated with significant and irregular calcification, which tends to be more present in the non-coronary sinus. Incomplete valve expansion, observable through fluoroscopy after implantation, can lead to alterations in the hemodynamic profile and favor structural deterioration of the percutaneous aortic valve.

Currently, both the true impact of incomplete expansion and the degree of expansion required to result in hemodynamic alterations or future adverse events remain unclear.

In this context, researchers conducted an analysis on 1216 patients who underwent transcatheter aortic valve replacement (TAVR) with SAPIEN or SAPIEN 3 balloon-expandable valves. The asymmetry index was assessed using the following formula (%): (greater height/lesser height) – 1 × 100. The result was considered high when it exceeded 5.5%.

A high asymmetry index (HAI) was observed in 206 patients (17.2%). Average patient age was 81 years, and 34% of subjects were women, with an STS mortality risk score of 4.3%. Most patients were functional class III-IV.

Seven percent of cases involved bicuspid valves, with an aortic valve area of 0.78 cm² and an ejection fraction of 55%. The average annular diameter was 25 mm. Patients with a HAI had higher gradients (65 mmHg vs. 60 mmHg for peak gradient and 43 mmHg vs. 39 mmHg for mean gradient, respectively).

Read also: Aortic Stenosis with High Gradients and Area >1: Just Follow Up?

A mean gradient ≥20 mmHg was more frequent in patients with HAI (18.7% [n = 39] vs. 1.2% [n = 12]; odds ratio [OR]: 19.34; 95% confidence interval [CI]: 9.32-40.16; P <0.001), and so was the presence of moderate to higher paravalvular leak (5.7% [n = 12] vs. 0.3% [n = 3]; OR: 19.70; 95% CI: 5.35-72.58; P <0.001).

In the receiver operating characteristics (ROC) curve analysis, asymmetry proved to be an excellent predictor of hemodynamic performance alterations in balloon-expandable valves (0.88; 95% CI: 0.84-0.92; P <0.001), with a cut-off point >5%, which had a 77-% sensitivity and an 86-% specificity.

Structural deterioration was similar between groups (3.9% vs. 3.6%; OR: 1.21; 95% CI: 0.51-2.86; P = 0.670). At 30 days, there were no differences in all-cause mortality or cardiovascular mortality (1.4% vs. 1.7% and 1% vs. 1.3%, respectively). There were also no differences in the incidence of mortality and stroke at one year.

Read also: SCAAR Registry: Coronary Angioplasty in Venous Grafts.

At 5 years of follow-up, there were no differences in all-cause mortality or cardiac mortality (21.1% vs. 26.2% and 13.9% vs. 17.6%, for HAI and for those without asymmetry, respectively).

Conclusion

The asymmetric expansion of balloon-expandable valves was associated with hemodynamic alterations in their functioning but did not impact long-term clinical outcomes.

Original Title: Asymmetrical Expansion of Balloon-Expandable Transcatheter Aortic Valve Prostheses Implications for Valve Hemodynamic and Clinical Outcomes.

Reference: Annette Maznyczka, et al. JACC Cardiovasc Interv. 2024;17:2011–2022.


Subscribe to our weekly newsletter

Get the latest scientific articles on interventional cardiology

Dr. Carlos Fava
Dr. Carlos Fava
Member of the Editorial Board of solaci.org

More articles by this author

Measuring Post-TAVI Gradients and Their Implications: Are Invasive and Echocardiographic Assessments Comparable?

Transcatheter aortic valve implantation (TAVI) is considered the treatment of choice for a significant proportion of patients with symptomatic aortic stenosis. Outcomes have improved...

Percutaneous Tricuspid Valve Replacement with Lux-Valve

Tricuspid regurgitation (TR) is a condition associated with poor quality of life, frequent hospitalizations due to heart failure, and increased mortality, even under optimal...

TAVR in Small Annuli: What Valve Should We Use?

One of the major challenges of severe aortic stenosis are patients with small aortic annuli, defined as ≤430 mm² aortic valve area. This condition...

ACC 2025 | TAVI in Low-Risk Patients: 5-Year Outcomes of EVOLUTE LOW RISK

Transcatheter aortic valve implantation (TAVI) is a valid alternative to surgery in low-risk patients with severe aortic stenosis. However, one of its main limitations...

LEAVE A REPLY

Please enter your comment!
Please enter your name here

Related Articles

SOLACI Sessionsspot_img

Recent Articles

Pretreatment with DAPT in Acute Coronary Syndrome: An Ongoing Debate?

In acute coronary syndrome (ACS) dual antiplatelet therapy (DAPT) has become a fundamental pillar after percutaneous coronary intervention (PCI), preventing stent thrombosis and acute...

Measuring Post-TAVI Gradients and Their Implications: Are Invasive and Echocardiographic Assessments Comparable?

Transcatheter aortic valve implantation (TAVI) is considered the treatment of choice for a significant proportion of patients with symptomatic aortic stenosis. Outcomes have improved...

Another Blow for Intra-Aortic Balloon Pumo Counterpulsation? Randomized Study on Its Use in Chronic Heart Failure Progressing to Cardiogenic Shock

Cardiogenic shock (CS) remains a condition with extremely high mortality (around 50%). While most therapies for this pathology have been studied in CS secondary...