Comparison of hemodynamic performance of self-expandable CoreValve versus balloon-expandable Edwards SAPIEN aortic valves inserted by catheter for aortic stenosis.
Transcatheter aortic valve implantation with the self-expandable CoreValve (CV) and the balloon-expandable Edwards SAPIEN (ES) bioprostheses has been widely used for the treatment of severe aortic stenosis. However, a direct comparison of the hemodynamic results associated with these 2 prostheses is lacking. The aim of the present study was to compare the hemodynamic performance of both bioprostheses. A total of 41 patients who underwent transcatheter aortic valve implantation with the CV prosthesis were matched 1:1 for prosthesis size (26 mm), aortic annulus size, left ventricular ejection fraction, body surface area, and body mass index with patients who underwent transcatheter aortic valve implantation with the ES prosthesis. Doppler-echocardiographic data were prospectively collected before the intervention and at hospital discharge, and all examinations were sent to, and analyzed in, a central echocardiography core laboratory. The mean transprosthetic residual gradient was lower (p = 0.024) in the CV group (7.9 ± 3.1 mm Hg) than in the ES group (9.7 ± 3.8 mm Hg). The effective orifice area tended to be greater in the CV group (1.58 ± 0.31 cm(2) vs 1.49 ± 0.24 cm(2), p = 0.10). The incidence of severe prosthesis-patient mismatch was, however, similar between the 2 groups (effective orifice area indexed to the body surface area ≤0.65 cm(2)/m(2); CV 9.8%, ES 9.8%, p = 1.0). The incidence of paravalvular aortic regurgitation was greater with the CV (grade 1 or more in 85.4%, grade 2 or more in 39%) than with the ES (grade 1 or more in 58.5%, grade 2 or more in 22%; p = 0.001). The number and extent of paravalvular leaks were greater in the CV group (p <0.01 for both comparisons). In conclusion, transcatheter aortic valve implantation with the CV prosthesis was associated with a lower residual gradient but a greater rate of paravalvular aortic regurgitation compared to the ES prosthesis. The potential clinical consequences of the differences in hemodynamic performance between these transcatheter heart valves needs to be addressed in future studies.
Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.
Luis
L
Nombela-Franco
Marc
M
Ruel
Sam
S
Radhakrishnan
John G
JG
Webb
Marc
M
Hansen
Marino
M
Labinaz
Chris
C
Thompson
Stephen
S
Fremes
Eric
E
Dumont
Robert
R
DeLarochellière
Daniel
D
Doyle
Marina
M
Urena
Michael
M
Mok
Henrique Barbosa
HB
Ribeiro
Idan
I
Roifman
Stuart
S
Watkins
Jean G
JG
Dumesnil
Philippe
P
Pibarot
Josep
J
Rodés-Cabau
D000369:Aged, 80 and over; D000704:Analysis of Variance; D015906:Angioplasty, Balloon, Coronary; D001022:Aortic Valve Insufficiency / Q000209:etiology; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D015415:Biomarkers / Q000097:blood; D001705:Bioprosthesis / Q000009:adverse effects; D006328:Cardiac Catheterization; D016009:Chi-Square Distribution; D015150:Echocardiography, Doppler; D005260:Female; D006350:Heart Valve Prosthesis / Q000009:adverse effects; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000379:methods*; D006439:Hemodynamics; D006801:Humans; D008297:Male; D011446:Prospective Studies; D018709:Statistics, Nonparametric; D016896:Treatment Outcome
D015415:Biomarkers