Page 24 - Journal of Structural Heart Disease Volume 5, Issue 6

Original Scientific Article
Journal of Structural Heart Disease, December 2019, Volume 5, Issue 6:248-253
DOI: https://doi.org/10.12945/j.jshd.2019.004.19
Received: February 05, 2019 Accepted: February 26, 2019 Published online: December 2019
Predictors of Paravalvular Aortic Regurgitation Following Transcatheter Aortic Valve Replacement Using the New EvolutTM PRO System
Teresa Alvarado Casas, MD, Fernando Rivero Crespo, MD*, Javier Cuesta Cuesta, MD, Esther González, MD, Alberto Vera, MD, Antuña Paula, MD, Guillermo Diego, MD, Jesús Jiménez Borreguero, MD, Fernando Alfonso, MD
Cardiology Department, Hospital Universitario de la Princesa, Madrid, Spain
Abstract
Background and Objective: The Evolut Pro (EVP) is a novel self-expandable aortic valve. This prosthesis con- sists of an external porcine pericardial wrap designed to reduce paravalvular leak (PVL), maintaining the benefits of its predecessor. The objective was to assess predictors of PVL using this novel device (d minuscule).
Methods: Twenty-seven consecutive patients with severe symptomatic aortic stenosis undergoing tran- scatheter aortic valve replacement using the CoreV- alve EVP bioprosthesis between October 2017 and July 2018, were prospectively recruited.
Patients were divided into two groups according to the presence of PVL: no or trace PVL versus mild or grade II PVL. The groups were compared to identify the demographic, echocardiographic and CT parameters predictive of PVL
Results: Pre-discharge transthoracic echocardiog- raphy revealed mild or grade II PVL in 19 cases (70%) (16 patients mild PVL; 3 grade II PVL). There were no patients with grade III or severe (grade IV) PVL. In all patients, the regurgitation was paravalvular. The pros- thesis/annulus discongruence (prosthesis diameter – CT mean annular diameter) was significantly related to the occurrence of mild/grade II PVL (4.4±0.9 mm in the mild/moderate PVL group, versus 5±0.5 mm in the group without or trace PVL; p=0.04).
Conclusions: EVP system remains associated with
mild or grade II PVL in a significant number of patients. However, hemodynamically significant PVL was not detected in any patient. The prosthesis/annulus dis- congruence plays a major role in the occurrence of residual PVL.
Copyright © 2019 Science International Corp.
Key Words
Aortic stenosis • Transcatheter aortic valve replacement • Paravalvular leak • Computed tomography • Echocardiography
Introduction
Transcatheter aortic valve replacement (TAVR) has become standard therapy for patients with severe aortic stenosis who are deemed of at least interme- diate risk for surgical valve replacement (SAVR). The current commercially available valves are broadly grouped into balloon-expandable and self-expand- able valves [1]. However, there is significant clinical concern regarding the higher incidence of paraval- vular leak (PVL) with TAVR as compared to SAVR as this has been associated with poor long-term clin- ical outcomes [2]. The CoreValveTM system was the first-generation self-expandable valve introduced to the market. The second-generation device was the
* Corresponding Author:
Fernando Alfonso Manterola, MD
Department of Cardiology
Hospital Universitario de La Princesa. Universidad Autónoma de Madrid. Instituto de Investigación Sanitaria Princesa, IIS-IP.
Diego de León 62, CIBER-CV, Madrid 28006, Madrid, Spain
Tel.: +616 52 06 35; E-Mail: falf@hotmail.com
Fax +1 203 785 3346
E-Mail: jshd@scienceinternational.org http://structuralheartdisease.org/
© 2019 Journal of Structural Heart Disease Published by Science International Corp. ISSN 2326-4004
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