Mid-term impact of underfilling and overfilling of the SAPIEN 3 balloon-expandable transcatheter aortic valve implantation on mortality and valve function.
Kenichi IshizuShinichi ShiraiHiroaki TashiroKazuki KitanoHiroyuki TabataToru MorofujiMiho NakamuraNaoto MurakamiTakashi MorinagaMasaomi HayashiAkihiro IsotaniYoshio AraiNobuhisa OhnoShinichi KakumotoKenji AndoPublished in: Heart and vessels (2022)
At present, underfilling or overfilling the volume of the balloon-expandable transcatheter heart valve (THV) is generally utilized in transcatheter aortic valve implantation (TAVI). However, no research has assessed the clinical impact of filling volume variations of the current-generation SAPIEN 3 THV. We analyzed the clinical data of 331 patients who underwent TAVI with SAPIEN 3 at our institution. Post-procedural echocardiographic and multidetector computed tomography (MDCT) scan data and 3-year prognoses according to each filling volume were assessed. The procedural outcomes and 3-year mortality rates were comparable among the underfilling, nominal filling, and overfilling groups. For all THV sizes, the THV area evaluated on post-procedural MDCT scan increased stepwise along with an elevated filling volume, thereby covering a wide range of native annulus area. Compared with patients in the nominal filling and overfilling groups, those with 23-mm THVs in the underfilling group had a smaller effective orifice area (EOA) (1.38 [IQR: 1.18-1.56] vs. 1.57 [IQR: 1.41-1.84] vs. 1.58 [IQR: 1.45-1.71] cm 2 , P = 0.02) and a higher mean transvalvular gradient (13.6 [IQR: 11.0-15.7] vs. 12.1 [IQR: 9.0-14.9] vs. 12.0 [IQR: 8.1-14.8] cm 2 , P = 0.04). In conclusion, by adjusting the filling volume of SAPIEN 3 using THV with limited sizes, continuously distributed native annulus areas were covered. The underfilling implantation technique had a minimal negative effect on the valve function of 23-mm THVs only. In the entire cohort, the filling volume variations did not affect the mid-term prognosis negatively.
Keyphrases
- transcatheter aortic valve implantation
- aortic valve
- aortic stenosis
- ejection fraction
- aortic valve replacement
- transcatheter aortic valve replacement
- computed tomography
- end stage renal disease
- chronic kidney disease
- heart failure
- peritoneal dialysis
- type diabetes
- magnetic resonance imaging
- cardiovascular disease
- risk factors
- electronic health record
- magnetic resonance
- patient reported outcomes
- contrast enhanced
- positron emission tomography
- coronary artery disease
- skeletal muscle
- adipose tissue
- deep learning
- data analysis
- artificial intelligence
- neural network