LVOT calcification was found in 25.3% of TAVI patients; newer-generation THVs reduced paravalvular leakage and improved hemodynamics vs. older valves without mortality difference.
Do newer-generation transcatheter heart valves improve procedural and hemodynamic outcomes compared to older-generation valves in patients with severe aortic stenosis and significant LVOT calcification?
Newer-generation transcatheter heart valves improve hemodynamic outcomes and reduce paravalvular leak compared to older-generation valves in patients with severe aortic stenosis and significant LVOT calcification.
Tasa de eventos absoluta: 0% vs 0%
Abstract Background Significant left ventricular outflow tract (LVOT) calcification is associated with adverse outcomes following TAVI. Data on its impact in patients receiving newer-generation transcatheter heart valves (THV) remain limited. Objectives This study assessed LVOT calcification prevalence in TAVI patients treated with newer-generation THV and its impact on procedural aspects, clinical, and hemodynamic outcomes using a single-center analysis. Methods 805 patients with severe aortic stenosis (AS) treated with newer-generation THV (Evolut Pro/Pro+, Sapien 3/Ultra, Navitor, Acurate Neo/Neo2) from 2020-2022 were analyzed. Patients without adequate contrast-enhanced multislice computed tomography for LVOT calcium quantification were excluded. Significant LVOT calcification was defined as calcium volume 10 mm³. Propensity score matching compared these patients to those receiving older-generation THV (Sapien 3, Acurate Neo, Portico, Evolut R) from 2012-2018. Results Significant LVOT calcification was present in 25,3% (N=204). These patients were more often male but did not differ in age or comorbidities compared to controls (N=601), presented with higher mean aortic valve pressure gradients (37.0mmHg vs. 32.0mmHg, p0.001), received larger valve sizes (29.0mm vs. 26.0mm, p0.001) and more often underwent pre- (84.6% vs. 69.6%, p0.001) and postdilatation (49.2% vs. 38.9%, p=0.014). Fluoroscopy time (18.0min vs. 14.1min, p0.001) and contrast medium usage (162.5ml vs. 146.0ml, p0.001) were increased. At discharge, LVOT calcification was associated with lower gradients (7.0 mmHg vs. 9.0 mmHg, p0.001) but higher rates of ≥moderate paravalvular leakage (PVL) (3.0% vs. 0.3%, p=0.0044). Sapien 3/Ultra use in patients with LVOT calcification correlated with reduced PVL≥mild (OR 0.23, 95% CI 0.09-0.62, p=0.0035) and lower postdilatation rates (OR 0.30, 95% CI 0.15-0.58, p0.001) vs. Evolut Pro/Pro+. 30-day (p=0.64) and 1-year (p=0.97) all-cause mortality showed no significant differences, as well as for composite endpoints of death/stroke (30d p=0.75; 12M p=0.4) and death/rehospitalization (30d p=0.53; 12M p=0.78). After propensity score matching (n=150 per group), newer-generation THV recipients had lower STS scores (5.2% vs. 6.9%, p0.001), received larger valves (29.0 mm vs. 26.0 mm, p0.001), underwent more postdilatation (50.0% vs. 32.0%, p=0.0019), and had shorter procedures (64.0 min vs. 80.0 min, p0.001) compared to older-generation THV recipients. They exhibited lower PVL ≥mild rates (24.1% vs. 52.9%, p0.001) and lower discharge gradients (7.0 mmHg vs. 9.0 mmHg, p0.001). Mortality rates at 30 days (p=0.72), 1 year (p=0.35), and 3 years (p=0.32) remained comparable. Conclusions LVOT calcification was present in 25.3% of TAVI patients receiving newer-generation THV. Propensity-matched analysis suggests improved procedural and hemodynamic outcomes with newer- vs. older-generation THVs.
Heide et al. (Sat,) reported a other. LVOT calcification was found in 25.3% of TAVI patients; newer-generation THVs reduced paravalvular leakage and improved hemodynamics vs. older valves without mortality difference.
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