title: The effect of surgical and transcatheter aortic valve replacement on mitral annular anatomy.
abstract: BACKGROUND
  The effect of aortic valve replacement on three-dimensional mitral annular geometry has not been well described. Emerging transcatheter approaches for aortic valve replacement employ fundamentally different mechanical techniques for achieving fixation and seal of the prosthetic valve than standard surgical aortic valve replacement. This study compares the immediate impact of transcatheter aortic valve replacement (TAVR) and standard surgical aortic valve replacement (AVR) on mitral annular anatomy.
  
  
  METHODS
  Real-time three-dimensional echocardiography was performed in patients undergoing TAVR using the Edwards Sapien valve (n = 10 [Edwards Lifesciences, Irvine, CA]) or AVR (n = 10) for severe aortic stenosis. Mitral annular geometric indexes were measured using Tomtec EchoView (Tomtec Imaging Systems, Munich, Germany) to assess regional and global annular geometry.
  
  
  RESULTS
  Mixed between-within analysis of variance showed no differences between TAVR and AVR groups in any of the mitral annular geometric indices preoperatively. However, postoperative analysis did demonstrate an effect of AVR on geometry. Patients undergoing open AVR had significant decrease in annular height, septolateral diameter, mitral valve transverse diameter, and mitral annular area after valve replacement (p ≤ 0.006). Similar changes were not noted in the TAVR group.
  
  
  CONCLUSIONS
  Mitral annular geometry is better preserved by TAVR than by AVR. Thus, TAVR may be a more physiologic approach to aortic replacement.
authors.affiliation: Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
authors.forename: Mathieu
authors.initials: M
authors.lastname: Vergnat
authors.forename: Melissa M
authors.initials: MM
authors.lastname: Levack
authors.forename: Benjamin M
authors.initials: BM
authors.lastname: Jackson
authors.forename: Joseph E
authors.initials: JE
authors.lastname: Bavaria
authors.forename: Howard C
authors.initials: HC
authors.lastname: Herrmann
authors.forename: Albert T
authors.initials: AT
authors.lastname: Cheung
authors.forename: Stuart J
authors.initials: SJ
authors.lastname: Weiss
authors.forename: Joseph H
authors.initials: JH
authors.lastname: Gorman
authors.forename: Robert C
authors.initials: RC
authors.lastname: Gorman
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D006328:Cardiac Catheterization; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D008297:Male; D008943:Mitral Valve / Q000033:anatomy & histology* / Q000000981:diagnostic imaging*; D014463:Ultrasonography