Clin Res Cardiol (2022). https://doi.org/10.1007/s00392-022-02002-5

Hemodynamics of Self-Expanding versus Balloon-Expandable Transcatheter Heart Valves in relation to Native Aortic Annulus Anatomy

S. Schmidt1, V. Fortmeier2, S. Ludwig3, H. S. Wienemann1, M. I. Körber1, S. Lee4, M. Meertens1, S. Macherey-Meyer1, E. Kuhn5, K. Eghbalzadeh5, S. Baldus6, N. Schofer7, T. K. Rudolph2, M. Adam1, V. Mauri1

1Klinik III für Innere Medizin, Herzzentrum der Universität zu Köln, Köln; 2Klinik für Kardiologie, Herz- und Diabeteszentrum NRW, Bad Oeynhausen; 3Klinik für Kardiologie, Universitäres Herz- und Gefäßzentrum Hamburg GmbH, Hamburg; 4Klinik III für Kardiologie, Angiologie, Pneumologie und Internistische Intensivmedizin, Universitätsklinikum Köln, Köln; 5Klinik und Poliklinik für Herz- und Thoraxchirurgie, Herzzentrum, Universitätsklinikum Köln, Köln; 6Klinik für Kardiologie, Angiologie, Pneumologie und Internistische Intensivmedizin, Herzzentrum der Universität zu Köln, Köln; 7Allgemeine und Interventionelle Kardiologie, Universitäres Herz- und Gefäßzentrum Hamburg GmbH, Hamburg;

Objectives: This study aimed to compare hemodynamic characteristics of different self-expanding (SE) and balloon-expandable (BE) transcatheter heart valves (THV) in relation to native aortic annulus anatomy. Background: A patient centered THV selection becomes increasingly important as TAVR indications are broadened towards lower risk populations. Methods: 2609 patients were treated at 3 centers in Germany with SAPIEN 3 (n=1146), ACURATE Neo (n=649), Evolut R (n=546) or Evolut Pro (n=268) THV. Hemodynamic parameters including mean gradient (MG), effective orifice area (EOA), Doppler velocity index (DVI), degree of paravalvular regurgitation (PVR) and patient-prosthesis mismatch (PPM) were compared by valve type, label size and in relation to quintiles of native aortic annulus area. Results: SE THVs provided superior hemodynamics in terms of larger EOA, higher DVI and lower MG compared to BE THV, especially in patients with small aortic annuli. Severe PPM was less frequent in SE treated patients. The rate of PVR ≥moderate was comparable for SE and BE devices in smaller annular dimensions, but remarkably lower for BE TAVR in large aortic annular dimensions (>547.64 mm²) (2% SAPIEN 3 vs. >10% for SE devices, p<0.001). Conclusions: Patients with small aortic annular dimensions may benefit hemodynamically from SE THVs. With increasing annulus size, BE THVs may have advantages since PVR ≥ moderate occurs less frequently.

https://dgk.org/kongress_programme/jt2022/aP1860.html