Comparison of 26-mm Evolut and 23-mm Sapien 3 Valves in TAVR for Small Aortic Annulus.

Publication Title

The Journal of invasive cardiology

Authors

Ruyun Jin, Center for Cardiovascular Analytics, Research, and Data Science; Providence St Joseph Heart Institute, Portland, ORFollow
Emily J Cox, Providence Sacred Heart Medical CenterFollow
Branden Reynolds, Providence Spokane Heart Institute, Providence St. Joseph Health, Spokane, WAFollow
Brydan Curtis, Providence St. Joseph HealthFollow
Robert W. Hodson, Providence Valve Center, St. Vincent Medical Center, Portland, Oregon, USAFollow
Michael Reed, International Heart Institute of Montana, Missoula, MontanaFollow
Sameer Gafoor, Swedish Heart and Vascular, Seattle, WA, USA.Follow
Gary Grunkemeier, Providence St Vincent Medical Center, Portland, ORFollow
Matthew Forrester, Providence Spokane Heart Institute, Providence St. Joseph Health, Spokane, WAFollow
Michael Ring, Providence Sacred Heart Medical Center, Spokane, Washington.Follow

Document Type

Article

Publication Date

6-1-2022

Keywords

washington; spokane; cards; TAVR; prosthesis-patient mismatch; small aortic annulus; surgical outcomes; transcatheter aortic valve replacement; Aortic Valve; Aortic Valve Stenosis; Heart Valve Prosthesis; Humans; Prosthesis Design; Risk Factors; Transcatheter Aortic Valve Replacement; Treatment Outcome

Abstract

BACKGROUND: Patients with small aortic annuli (SAA) are prone to higher post-transcatheter aortic valve replacement (TAVR) transvalvular gradients and development of prosthesis-patient mismatch (PPM). In many patients with SAA, the choice of TAVR valve commonly involves choosing between the 26-mm Medtronic Evolut 2 (ME26) or the 23-mm Edwards Sapien 3 valve (ES23). We compared echocardiographic and clinical outcomes in patients with SAA undergoing TAVR with either valve.

METHODS: We queried the Providence St. Joseph Health Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry database for patients undergoing TAVR with either the ES23 or ME26 between July 2015 and December 2018 at 11 hospitals. Post-TAVR echocardiographic and clinical results in-hospital, at 1 month, and at 1 year were examined. High gradient (HG) was defined as mean gradient (MG) ≥20 mm Hg.

RESULTS: We identified 1162 patients with SAA undergoing TAVR with either the ME26 (n = 233) or ES23 valve (n = 929). Baseline characteristics between groups were similar. At 1 month, the ME26 was associated with a lower MG than the ES23 (7.7 ± 4.7 mm Hg vs 13.1 ± 4.9 mm Hg; P

CONCLUSION: TAVR in SAA with the ME26 is associated with lower incidence of HG or PPM compared with the ES23. While clinical outcomes at 1 year were similar, the long-term implications of these findings remain unknown.

Area of Special Interest

Cardiovascular (Heart)

Specialty/Research Institute

Cardiology

Specialty/Research Institute

Center for Cardiovascular Analytics, Research + Data Science (CARDS)