Clinical results with the 31 mm CoreValveª in large aortic annuli: the importance of implantation technique.

AIMS: The CoreValve Revalving System (CRS) (Medtronic Inc., Minneapolis, MN, USA) is currently available in four sizes: 23 mm, 26 mm, 29 mm and 31 mm. Aim of our study was to assess the acute clinical results after implantation of a 31 mm CRS. METHODS AND RESULTS: We assessed device safety, procedural success and 30-day outcomes of 76 consecutive patients who underwent transcatheter aortic valve implantation (TAVI) from January 2012 to September 2013, for severe aortic valve disease. The device sizes used were 26 mm in 21 (28%), 29 mm in 20 (26%) and 31 mm in 35 (46%) patients. Patients who received the 31 mm CRS were significantly younger, predominantly male, with higher STS scores and lower left ventricular ejection fraction. Device success was obtained in 70 cases (92%) in the overall population, without significant differences among groups. Procedural, fluoroscopy and revalving time and procedural outcomes did not differ. A significant reduction in transaortic gradient was obtained in all groups. We observed a low incidence of paraprosthetic leak in the 31 mm group. Permanent pacemaker implantation, bleeding, vascular and renal complications were similar among groups. Time of hospitalisation in CRS 31 mm patients did not differ from the other groups and 30-day outcomes were comparable. CONCLUSIONS: The 31 mm CRS can be safely implanted in patients with complex aortic valve disease, large annuli and dilated left ventricles.