Key result
Borderline aortic annulus in TAVR was associated with a significantly higher transvalvular gradient (17.81 vs 14.44) and paravalvular leakage compared to non-borderline annulus (P<.001).
Why the study?
Optimal valve sizing improves TAVR outcomes, but operators hesitate about valve size selection when aortic annulus measurements fall into a borderline area.
Does TAVR in patients with a borderline aortic annulus result in worse paravalvular leakage and transvalvular gradient compared to those with a non-borderline annulus?
Cohort (n=338)
Does TAVR in patients with a borderline aortic annulus result in worse paravalvular leakage and transvalvular gradient compared to those with a non-borderline annulus?
Patients with a borderline aortic annulus undergoing TAVR have significantly higher residual transvalvular gradients and rates of paravalvular leakage compared to those with a non-borderline annulus, regardless of valve type or sizing strategy.
May warrant closer post-TAVR surveillance in borderline annuli; leaves open optimal sizing strategies for prospective trials.
BACKGROUND: Optimal valve sizing provides improved results in transcatheter aortic valve replacement. Operators hesitate about the valve size when the annulus measurements fall into borderline area. Our purpose was to compare the results of borderline versus non-borderline annulus and to understand the impact of valve type and under or oversizing. METHODS: Data from 338 consecutive transcatheter aortic valve replacement procedures were analyzed. The study population was divided into 2 groups as 'borderline annulus' and 'non-borderline annulus.' Balloon expandable valves already have a grey zone definition. Similar to balloon expandable valves, annulus sizes that are within 15% above or below the upper or lower limit of a particular self-expandable valve size are defined as the 'borderline annulus' for self-expandable valves. The borderline annulus group was also divided into 2 subgroups according to the smaller or larger valve selection as 'undersizing' and 'oversizing.' Comparisons were made regarding the paravalvular leakage and residual transvalvular gradient. RESULTS: Of these 338 patients, 102 (30.1%) had a borderline and 226 (69.9%) had a non-borderline annulus. Both the transvalvular gradient (17.81 ± 7.15 vs. 14.44 ± 6.27) and the frequency of paravalvular leakage (for mild, mild to moderate, and moderate, 40.2%, 11.8%, and 2.9% vs., 18.8%, 6.7%, and 0.4%, respectively) were significantly higher in the borderline annulus than the non-borderline annulus group (P <.001). There were no significant differences between the groups balloon expandable versus self-expandable valves and oversizing versus undersizing regarding the transvalvular gradient and paravalvular leakage in patients with borderline annulus (P >.05). CONCLUSION: Regardless of the valve type and oversizing or undersizing, borderline annulus is related to significantly higher transvalvular gradient and paravalvular leakage when compared to the non-borderline annulus in transcatheter aortic valve replacement.
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Erkan Yıldırım (2023) conducted a cohort in Transcatheter aortic valve replacement (n=338). Borderline aortic annulus vs. Non-borderline aortic annulus was evaluated on Transvalvular gradient (p=<.001). Borderline aortic annulus in TAVR was associated with a significantly higher transvalvular gradient (17.81 vs 14.44) and paravalvular leakage compared to non-borderline annulus (P<.001).
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