DurAVR transcatheter heart valve implantation reduced indexed flow displacement to levels comparable to healthy controls (3.5 vs 3.5 %/cm²; P=0.81) at 6 months.
Observational (n=141)
Does TAVR with the DurAVR transcatheter heart valve improve ascending aortic flow parameters in patients with symptomatic severe aortic stenosis?
The biomimetic DurAVR transcatheter heart valve restores ascending aortic flow towards native physiology and is associated with significant left ventricular mass regression at 6 months.
Absolute Event Rate: 3.5% vs 3.5%
p-value: p=0.81
Abstract Background Abnormal ascending aortic flow can persist after transcatheter aortic valve replacement (TAVR) and may contribute to aortopathy and incomplete left ventricular mass regression. The DurAVR transcatheter heart valve is designed to reproduce native leaflet shape and restore flow. Methods In a prospective study, patients with symptomatic severe aortic stenosis underwent transthoracic echocardiography and cardiovascular magnetic resonance (CMR) before TAVR with DurAVR and at six months. Post-implant findings were compared with age-, sex-, and haemodynamics-matched controls without aortic valve disease. Ascending aortic flow displacement (FD) and flow reversal ratio (FRR) were quantified using phase-contrast imaging. Haemodynamic correlates of LV mass regression post-DurAVR were explored using multivariable analysis. Results One hundred and forty-one participants were studied with CMR (aortic stenosis, 60; DurAVR, 46; controls, 35). Thirty-nine patients had paired baseline and 6-month data. Compared to baseline, DurAVR reduced indexed FD (4.0±1.2 to 3.5±0.8 %/cm², P0.005) and indexed FRR (3.9±1.0 to 2.6±0.7 %/cm², P0.0001). Post DurAVR, indexed FD was comparable to controls (3.5±0.8 vs 3.5±1.3 %/cm², P=0.81) and indexed FRR approached control values (2.5±0.7 vs 2.2±0.8 %/cm², P=0.06). Left ventricular mass regressed by 18% (P0.0001). In regression (R2=0.43), left ventricular mass regression was independently associated with the change in the mean transaortic gradient (relative contribution 68%, P=0.005) and change in systolic FRR (relative contribution 26%, P=0.03). Conclusion DurAVR THV implantation restored ascending aortic flow towards native physiology and was accompanied by left ventricular reverse remodelling at six months. Larger comparative studies should determine whether normalised post-implant flow translates into improved patient outcomes.
Garg et al. (Fri,) conducted a observational in Symptomatic severe aortic stenosis (n=141). DurAVR transcatheter heart valve vs. Age-, sex-, and haemodynamics-matched controls without aortic valve disease was evaluated on Indexed flow displacement (FD) (p=0.81). DurAVR transcatheter heart valve implantation reduced indexed flow displacement to levels comparable to healthy controls (3.5 vs 3.5 %/cm²; P=0.81) at 6 months.