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Rapid Fire Abstract session: new insights in TAVI334Transcatheter heart valve underexpansion patterns335Echocardiography after TAVI with directflow medical prosthesis: small leaks and high gradients336Effects of transcatheter aortic valve implantation on left ventricular and atrial function evaluated by two and three-dimensional speckle tracking at eighteen-month follow-up337Impact of tricuspid regurgitation and right ventricular dysfunction on outcome of patients undergoing trans-catheter …

2015; Oxford University Press; Volume: 16; Issue: suppl 2 Linguagem: Inglês

10.1093/ehjci/jev256

2047-2412

Bingkui Ren, T Sturmberger, R Ancona, SL Schwartz, David Martin, P Szymanski, F Islas, M Muratori, J Mcghie, S Van Weenen, R Rodriguez-Olivares, L Van Gils, ML. Geleijnse, PPT De Jaegere, NMDA Van Mieghem, C Ebner, W Tkalec, V Eder, J Aichinger, S. Comenale Pinto, P Caso, I Monteforte, MG Coppola, V Sellitto, M Macrino, A Ferro, Raffaele Calabrò, RZ Rozenbaum, Y Topilsky, C Fraile Sanz, Luisa Salido Tahoces, R Hernandez-Antolin, C Fernandez-Golfin, JL Mestre Barcelo, E Casas Rojo, JL Zamorano Gómez, T Hryniewiecki, J Jastrzebski, M Dabrowski, D Sorysz, J Kochman, T Kukulski, M Zembala, C Almeria, C Olmos, E Garcia, L Nombela, P Marcos-Alberca, JA De Agustin, P Mahia, C Macaya, Leopoldo Pérez de Isla, L Fusini, Sarah Ghulam Ali, G Tamborini, P Gripari, Larissa Maria Salvi, A. Bartorelli, F Alamanni, M Pepi,

Cardiovascular Function and Risk Factors

Background: The size of the transcatheter heart valves (THV) is overestimated up to 20% based on aortic annulus diameter measured using computed tomography (CT).However, the prosthesis may not be fully expanded during implantation.THV underexpansion might have detrimental clinical consequences.Purpose The aim of this study was to define the degree of underexpansion degree of different THVs after implantation, introduced as the shrinking index.Methods: In total we enrolled 114 patients (68 men, 79 + 8 years old) who underwent transcatheter aortic valve implantation (TAVI) with the self-expanding CoreValve (n=28 patients), mechanically expanded Lotus valve (n= 37) or balloon expandable Edwards SAPIEN XT (n=18) and Edwards SAPIEN 3 (n= 31).The cover index of the THV was calculated as the percentage difference of the nominal prosthesis size and annulus diameter measured using CT.Intraprocedural transesophageal echocardiography (TEE) was performed to determine the size of the THV inflow after implantation.The shrinking index was calculated as the percentage of the difference between the inflow size by TEE and the nominal prosthesis size divided by prosthesis size.Results: Cover index per CTassessment before TAVI was 18 + 7% for CoreValve, 2 + 4% for Lotus, 9 + 5% for Edwards SAPIEN and 4 + 5% for Edwards SAPIEN 3 (ANOVA p , 0.001, Corevalve was significantly larger than the others).Compared with aortic annulus diameter measured using TEE in long axis view, the overestimation increased to 28 + 9% for CoreValve, 12 + 8% for Lotus, 18 + 12% for Edwards SAPIEN and 12 + 8% for Edwards SAPIEN 3 (ANOVA p , 0.001, Corevalve was significantly larger than the others).Conversely, the shrinking index after TAVI was -31 + 6% for CoreValve, -20 + 5% for Lotus, -22 + 6% for SAPIEN XT and -19 + 5% for SAPIEN 3 (ANOVA p , 0.001, Corevalve was significantly larger than the others).The interobserver variability (relative difference) of TEE in measuring the aortic annulus and prosthesis inflow was 6 + 5% and 7 + 5% respectively. Conclusion:The shrinking index determines the degree of THV underexpansion after TAVI and can be reliably measured with TEE.The self-expanding CoreValve tended to be under-expanded the most, indicated by the largest shrinking index, while the underexpansion degree was comparable between Lotus valve, SAPIEN XT and SAPIEN 3. The clinical implications of the shrinking index requires further study.