Original Scientific Articles
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Journal of Structural Heart Disease, December 2019, Volume 5, Issue 6:248-253
DOI: 10.12945/j.jshd.2020.004.19
Predictors of Paravalvular Aortic Regurgitation Following Transcatheter Aortic Valve Replacement Using the New Evolut™ 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 consists 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 transcatheter aortic valve replacement using the CoreValve 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 echocardiography 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 prosthesis/ 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 discongruence plays a major role in the occurrence of residual PVL.
Cite this article as: Alvarado Casas T, Rivero Crespo F, Cuesta Cuesta J, González E, Vera A, Paula A, Diego G, Borreguero JJ, Alfonso F. Predictors of Paravalvular Aortic Regurgitation Following Transcatheter Aortic Valve Replacement Using the New Evolut™ PRO System. Structural Heart Disease 2019;5(6):248-253. DOI: 10.12945/j.jshd.2020.004.19
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Original Scientific Articles
Journal of Structural Heart Disease, December 2019, Volume 5, Issue 6:248-253
DOI: 10.12945/j.jshd.2020.004.19
Predictors of Paravalvular Aortic Regurgitation Following Transcatheter Aortic Valve Replacement Using the New Evolut™ 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 consists 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 transcatheter aortic valve replacement using the CoreValve 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 echocardiography 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 prosthesis/ 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 discongruence plays a major role in the occurrence of residual PVL.
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Cite this article as: Alvarado Casas T, Rivero Crespo F, Cuesta Cuesta J, González E, Vera A, Paula A, Diego G, Borreguero JJ, Alfonso F. Predictors of Paravalvular Aortic Regurgitation Following Transcatheter Aortic Valve Replacement Using the New Evolut™ PRO System. Structural Heart Disease 2019;5(6):248-253. DOI: 10.12945/j.jshd.2020.004.19
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