Aortic annulus angulation does not attenuate procedural success of transcatheter aortic valve replacement using a novel self-expanding bioprosthesis.
Heart Vessels
; 34(12): 1969-1975, 2019 Dec.
Article
em En
| MEDLINE
| ID: mdl-31134380
ABSTRACT
The objectives of the study were to evaluate the impact of aortic angulation (AA) on success of transcatheter aortic valve replacement (TAVR) with a new generation self-expandable prosthesis (Medtronic Evolut R®). Specific anatomical conditions, such as for example the presence of a horizontal aorta with elevated AA, have seemed to pose a significant challenge for the correct positioning and consequent functioning of self-expandable TAVR prostheses. We assessed 146 patients treated with Evolut R. AA was measured at computed tomography and two groups were identified using as cutoff the mean AA value. Acute outcomes were collected and compared. AA mean value was 49.6 ± 9.4° (AA ≥ 50° 76 and AA < 50° 70 patients). Risk profile (Logistic euroSCORE AA ≥ 50° 15.7; 75% IQR 11.1-22.1 vs. AA < 50° 14.7; 75% IQR 10.7-24.0; p = 0.8) was equivalent. Perioperative results were similar valve resheathing (AA ≥ 50° 21.0% vs. AA < 50° 24.2%; p = 0.6), recapturing (AA ≥ 50° 19.7% vs. AA < 50° 25.7%; p = 0.3), fluoroscopy time (AA ≥ 50° 11.1 IQR 8.6-17.0 min. vs. AA < 50° 11.0 IQR 8.0-15.7 min.; p = 0.9), and contrast agent use (AA ≥ 50° 99.0 ± 41.8 ml. vs. AA < 50° 104.2 ± 38.5 ml.; p = 0.4). At discharge, moderate paravalvular leak was present in 8/76 (10.5%) of the AA ≥ 50° and 6/70 (8.6%) of the AA < 50° (p = 0.7) patients. Severe paravalvular leak, implantation of a second valve, and/or conversion to surgery did not occur. Early safety (AA ≥ 50° 7.8% vs. AA < 50° 5.7%; p = 0.6) was similar in the two groups. AA did not affect procedural outcomes and valve performance of the Evolut R prosthesis.
Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Valva Aórtica
/
Estenose da Valva Aórtica
/
Bioprótese
/
Próteses Valvulares Cardíacas
/
Substituição da Valva Aórtica Transcateter
Tipo de estudo:
Diagnostic_studies
/
Etiology_studies
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Limite:
Aged80
/
Female
/
Humans
/
Male
Idioma:
En
Ano de publicação:
2019
Tipo de documento:
Article