Page 28 - Journal of Structural Heart Disease Volume 5, Issue 6

Original Scientific Article
252
Sapien valve, Detaint et al. reported the occurrence of significant PVL to prosthesis/annulus discongruence [13] and Schultz et al. suggested that improved pros- thesis sizing, based on mean annulus diameter on CT, helped to reduce PVL with the Medtronic CorevalveTM [14]. To best of our knowledge, however, this is the first study systematically correlating residual PVL fol- lowing EvolutTM PRO TAVR with the prosthesis/annu- lus discongruence. Our findings underscore that ap- propriate sizing using CT (aiming for mild oversizing) remains critical to avoid residual PVL even with the use of the novel EvolutTM PRO System.
In our experience, the EvolutTM PRO’s new design is secure, but it is still associated with a significant incidence of residual mild/grade II PVL, higher than previously reported [4]. Only the prosthesis/annulus discongruence, as measured by CT, was identified as a PVL predictor. Nevertheless, further studies are re- quired to fully define the clinical repercussion of PVL, the clinical utility of assessing prosthesis/annulus dis- congruence in this setting, and to define other PVL predictors. Because the EvolutTM PRO system is a very new design, only a limited number of patients were included in the present study. Likewise, the potential clinical implications of the degree of PVL detected
in our study (mild/grade II) should be established in larger studies.
Conclusion
In conclusion, EvolutTM PRO system remains associ- ated 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 discongruence plays a major role in the oc- currence of residual PVL.
Acknowledgments
The authors wish to thank the work and dedication of the thoracic radiology department in the Hospital La Princesa
Conflict of Interest
The authors have no conflict of interest relevant to this publication.
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Journal of Structural Heart Disease, December 2019
Volume 5, Issue 6:248-253