Impact of commissural alignment on the hemodynamic performance of supra‐annular self‐expandable transcatheter aortic valves

Year: 2024

Type: article

Abstract: ABSTRACT Background Impact of commissural alignment (CA) strategies with self-expandable supra-annular transcatheter aortic valves (TAVR) has not been investigated yet. Methods Multicentric ambispective study including patients who underwent self-expandable TAVR in 7 centers with the Evolut Pro/Pro+ (EP)(Medtronic, USA) and Acurate neo2 (AN2)(Boston Scientific, USA). Comparison of those with CA attempt vs. those with no CA attempt was performed. The degree of commissural misalignment (CMA) was assessed by computed tomography/angiography and 1-year transvalvular gradients/regurgitation evaluated by echocardiography. A matched comparison according to annular dimensions/eccentricity, prosthesis size/type, and baseline left ventricular function and gradients was performed. Results A total of 557 patients, mean age 80.7±6.6 years, 61.4% men, and STS score of 4.3±3.1% were analyzed. A CA technique was attempted in 215 patients (38.6%), including 113 patients with AN2 and 102 patients with EP. None/mild CMA was found in 158 (73.5% vs. 43.6% if no CA attempted, p<0.001) with no differences between devices (AN2:75.2%; EP:71.6%, p=0.545). Patients with moderate/severe CMA had a greater aortic peak gradient (22.3±8.7 vs. 19.7±8.5, p=0.001), significantly greater progression of both peak (p=0.002) and mean gradients (p=0.001) after matching, and higher rate of central aortic regurgitation (1.2% vs. 0.4%, p=0.005) at 1-year, but not a greater proportion of patients with mean gradient ≥10mmHg. Conclusions The use of CA strategies significantly reduced the rate of CMA for the self-expandable TAVR devices ACN2 and EP which was associated to lower transvalvular gradients and intra-prosthetic regurgitation progression at 1-year although no criteria of structural deterioration were met at this follow up. Clinicaltrials.org: NCT05097183 CONDENSED ABSTRACT Commissural alignment (CA) strategies with Evolut Pro and Acurate neo2 TAVR devices were similarly successful in ¾ of the patients, representing a significant increase compared to traditional implantation. Patients with moderate/severe commissural misalignment (CMA) had a significantly greater progression of both peak and mean gradients and higher rate of new central aortic regurgitation at 1-year, but not a greater proportion of patients with mean gradient above 10mmHg. Hence, even at only 1-year of follow up and despite the lack of formal structural deterioration criteria, some hints suggest a more rapid deterioration if moderate/severe CMA is present after supra-annular TAVR.

Source: Catheterization and Cardiovascular Interventions

DOI: 10.1002/ccd.31201

Institutions: Instituto de Salud Carlos III, Centro de Investigación en Red en Enfermedades Cardiovasculares, Centro de Investigación Biomédica en Red, Hospital Clínico Universitario de Valladolid, Complexo Hospitalario Universitario A Coruña, Hospital Clínico San Carlos, Hospital Universitario La Paz, Hospital Clínico Universitario Virgen de la Victoria, Complejo Hospitalario Universitario de Santiago, Hospital Juan Ramón Jiménez

Language: English

Topic: Cardiac Valve Diseases and Treatments

Subfield: Cardiology and Cardiovascular Medicine

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: green

Funders: Boston Scientific Corporation, Sociedad Española de Cardiología, Instituto de Salud Carlos III

Awards: G7541582616, Validación clínica y evaluación pronóstica del alineamiento comisural preciso durante el implante de prótesis aórtica transcatéter: Proyecto ACA., G8937139782

OpenAlex ID: W4402419396