Heart valve sizing and clinical outcomes in patients undergoing transcatheter aortic valve implantation.

Okuno, Taishi; Heg, Dik; Lanz, Jonas; Praz, Fabien; Gräni, Christoph; Langhammer, Bettina; Reineke, David; Räber, Lorenz; Wenaweser, Peter; Pilgrim, Thomas; Windecker, Stephan; Stortecky, Stefan (2021). Heart valve sizing and clinical outcomes in patients undergoing transcatheter aortic valve implantation. (In Press). Catheterization and cardiovascular interventions Wiley-Blackwell 10.1002/ccd.29700

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OBJECTIVES

To investigate the impact of transcatheter heart valve (THV) sizing on procedural results and clinical outcomes following transcatheter aortic valve implantation (TAVI).

BACKGROUND

The impact of individual THV sizing for patients with borderline aortic annulus anatomy remains unclear.

METHODS

In the prospective BernTAVI registry, THV sizing conditions were retrospectively evaluated, and patients were categorized into three groups based on the recommendations and the sizing chart of the manufacturers: optimal sizing, borderline sizing (THV size located within 5% to each border of the optimal sizing recommendation), and suboptimal sizing (THV size outside the recommended range). The latter two groups were further subcategorized into THV-oversizing and THV-undersizing. The primary endpoint was a composite of all-cause death and unplanned repeat intervention at 1 year.

RESULTS

Out of a total of 1,638 patients who underwent TAVI, 9.5 and 15.6% of patients were categorized into the borderline and suboptimal sizing group, respectively. Device success was achieved in 87.4, 88.9, and 83.6% of patients with optimal, borderline, and suboptimal sizing, respectively. The primary endpoint occurred in 12.3% of patients with optimal sizing, 14.9% of patients with borderline sizing (HRadj 1.35, 95%CI 0.87-2.09), and in 17.4% of patients with suboptimal sizing (HRadj 1.42, 95%CI 1.01-1.99). Within the suboptimal sizing cohort, unfavorable outcomes were mainly associated with THV undersizing (device success: 76.4%, primary endpoint: 23.9%, HRadj 1.98, 95%CI 1.36-2.87).

CONCLUSION

Suboptimal TAVI prosthesis sizing is associated with an increased risk of all-cause death and unplanned repeat intervention within 1 year largely attributable to undersized THV prostheses.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiovascular Surgery
04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology
04 Faculty of Medicine > Pre-clinic Human Medicine > CTU Bern

UniBE Contributor:

Okuno, Taishi; Heg, Dierik Hans; Lanz, Jonas; Praz, Fabien Daniel; Gräni, Christoph; Langhammer, Bettina; Reineke, David Christian; Räber, Lorenz; Wenaweser, Peter Martin; Pilgrim, Thomas; Windecker, Stephan and Stortecky, Stefan

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1522-1946

Publisher:

Wiley-Blackwell

Language:

English

Submitter:

Andrea Flükiger-Flückiger

Date Deposited:

27 Apr 2021 17:42

Last Modified:

02 Jun 2021 19:10

Publisher DOI:

10.1002/ccd.29700

PubMed ID:

33857355

Uncontrolled Keywords:

aortic regurgitation device success multi-detector computed tomography sizing transcatheter aortic valve implantation transcatheter heart valve

BORIS DOI:

10.48350/155948

URI:

https://boris.unibe.ch/id/eprint/155948

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