Comparison of performance of self-expanding and balloon-expandable transcatheter aortic valves

Hatoum, Hoda; Samaee, Milad; Sathananthan, Janarthanan; Sellers, Stephanie; Kuetting, Maximilian; Lilly, Scott; Ihdayhid, Abdul Rahman; Blanke, Philipp; Leipsic, Jonathon; Thourani, Vinod H.; Dasi, Lakshmi Prasad

doi:10.1016/j.xjon.2022.04.015

Cited by 4 publications

(2 citation statements)

References 40 publications

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“…better sinus wash-out—with less blood stasis [ 34 ]and (3.) better flow patterns—with less systolic leaflet flutter [ 35 ] compared to other competitors are interesting observations. It should be noted that also after TAVI in native aortic valves good haemodynamic outcomes and a high safety profile has been described for the Allegra THV.…”

Section: Discussionmentioning

confidence: 99%

Comparison of a novel self-expanding transcatheter heart valve with two established devices for treatment of degenerated surgical aortic bioprostheses

et al. 2023

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Aims This study was performed to compare haemodynamic properties of a novel transcatheter heart valve (THV) with two established valve technologies for treatment of failing surgical aortic bioprosthetic valves (SAV). The ALLEGRA THV has been recently described with a proven safety and performance profile. Methods and results The study was designed as a retrospective, single-centre study investigating 112 patients (77.7 ± 7.1 years, 53.8% female, STS score 6.8 ± 5.8% and logEuroSCORE I 27.4 ± 16.1%) with failing SAV. Patients were treated with the ALLEGRA THV (NVT, n = 24), the CoreValve/EvolutR (MTD, n = 64) or the Edwards Sapien/Sapien XT/Sapien 3 (EDW, n = 24). Adverse events, haemodynamic outcomes and patient safety were analysed according to VARC-3 definitions. Overall procedural success was high (94.6%), even though 58.9% of the treated SAV were classified as small (true inner diameter < 21 mm). After treatment, the mean pressure gradient was significantly reduced (baseline: 33.7 ± 16.5 mmHg, discharge: 18.0 ± 7.1 mmHg), with a corresponding increase in effective orifice area (EOA). The complication rates did not differ in between groups. There was a trend to lower mean transvalvular gradients after implantation of self-expanding THV with supra-annular valve function, despite a higher frequency of smaller SAVs in the NVT and MTD group. Additionally, comparison between NVT and MTD revealed statistically lower transvalvular gradients (NVT 14.9 ± 5.0 mmHg, MTD 18.7 ± 7.5 mmHg, p = 0.0295) in a subgroup analysis. Conclusions Valve-in-valve (ViV) treatment of failing SAV with supra-annular design like the ALLEGRA THV resulted in favourable haemodynamic outcomes with similar low clinical event rates and may therefore be an interesting alternative for VIV TAVI. Graphical abstract

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Section: Discussionmentioning

confidence: 99%

Comparison of a novel self-expanding transcatheter heart valve with two established devices for treatment of degenerated surgical aortic bioprostheses

et al. 2023

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“…A previous computer simulation study on BEV for bicuspid AS demonstrated the tendency of BEV devices to expand asymmetrically in the aortic root [ 22 ]. Furthermore, another study showed differences between anatomical conformability of BEV versus SEV [ 23 ]. Notably, the BEV is characterized by high radial strength in the implanted host due to its high material strength.…”

Section: Discussionmentioning

confidence: 99%

Differences in blood flow dynamics between balloon- and self-expandable valves in patients with aortic stenosis undergoing transcatheter aortic valve replacement

Takahashi,

Kamiya,

Nagai

et al. 2023

Journal of Cardiovascular Magnetic Resonance

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Background The differences in pre- and early post-procedural blood flow dynamics between the two major types of bioprosthetic valves, the balloon-expandable valve (BEV) and self-expandable valve (SEV), in patients with aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR), have not been investigated. We aimed to investigate the differences in blood flow dynamics between the BEV and SEV using four-dimensional flow cardiovascular magnetic resonance (4D flow CMR). Methods We prospectively examined 98 consecutive patients with severe AS who underwent TAVR between May 2018 and November 2021 (58 BEV and 40 SEV) after excluding those without CMR because of a contraindication, inadequate imaging from the analyses, or patients’ refusal. CMR was performed in all participants before (median interval, 22 [interquartile range (IQR) 4–39] days) and after (median interval, 6 [IQR 3–6] days) TAVR. We compared the changes in blood flow patterns, wall shear stress (WSS), and energy loss (EL) in the ascending aorta (AAo) between the BEV and SEV using 4D flow CMR. Results The absolute reductions in helical flow and flow eccentricity were significantly higher in the SEV group compared in the BEV group after TAVR (BEV: − 0.22 ± 0.86 vs. SEV: − 0.85 ± 0.80, P < 0.001 and BEV: − 0.11 ± 0.79 vs. SEV: − 0.50 ± 0.88, P = 0.037, respectively); there were no significant differences in vortical flow between the groups. The absolute reduction of average WSS was significantly higher in the SEV group compared to the BEV group after TAVR (BEV: − 0.6 [− 2.1 to 0.5] Pa vs. SEV: − 1.8 [− 3.5 to − 0.8] Pa, P = 0.006). The systolic EL in the AAo significantly decreased after TAVR in both the groups, while the absolute reduction was comparable between the groups. Conclusions Helical flow, flow eccentricity, and average WSS in the AAo were significantly decreased after SEV implantation compared to BEV implantation, providing functional insights for valve selection in patients with AS undergoing TAVR. Our findings offer valuable insights into blood flow dynamics, aiding in the selection of valves for patients with AS undergoing TAVR. Further larger-scale studies are warranted to confirm the prognostic significance of hemodynamic changes in these patients.

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Guidelines for the Evaluation of Prosthetic Valve Function With Cardiovascular Imaging: A Report From the American Society of Echocardiography Developed in Collaboration With the Society for Cardiovascular Magnetic Resonance and the Society of Cardiovascular Computed Tomography

Zoghbi,

Jone,

Chamsi-Pasha

et al. 2024

Journal of the American Society of Echocardiography

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Comparison of performance of self-expanding and balloon-expandable transcatheter aortic valves

Cited by 4 publications

References 40 publications

Comparison of a novel self-expanding transcatheter heart valve with two established devices for treatment of degenerated surgical aortic bioprostheses

Comparison of a novel self-expanding transcatheter heart valve with two established devices for treatment of degenerated surgical aortic bioprostheses

Differences in blood flow dynamics between balloon- and self-expandable valves in patients with aortic stenosis undergoing transcatheter aortic valve replacement

Guidelines for the Evaluation of Prosthetic Valve Function With Cardiovascular Imaging: A Report From the American Society of Echocardiography Developed in Collaboration With the Society for Cardiovascular Magnetic Resonance and the Society of Cardiovascular Computed Tomography

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