title: Procedural results with the self-expanding 31 mm CoreValve aortic bioprosthesis in patients with large annuli.
abstract: BACKGROUND
  Transcatheter aortic valve implantation has become an established treatment for severe aortic stenosis in patients with high surgical risk. Due to its specific design, the self-expanding 31 mm CoreValve prosthesis can be technically challenging. This is especially true for patients with large annuli above 27.5 mm for which the CoreValve 31 mm device is the only option.
  
  
  OBJECTIVE
  To evaluate procedural results and short-term outcome with the 31 mm CoreValve device in patients with large annuli.
  
  
  METHODS
  We retrospectively analyzed 54 patients in whom we implanted a 31 mm self-expanding CoreValve bioprosthesis and compared them to 50 consecutive patients implanted with the smaller 29 mm device within the same period of time.
  
  
  RESULTS
  Patients with the 31 mm prosthesis had significantly higher rates of postinterventional pacemaker implantations (35% vs. 20%; P = 0.036) despite similar implantation depths (6.5 ± 4 vs. 7.5 ± 4; P = 0.34). However, the number of deep implantations (>8 mm) was significantly higher (P = 0.045). No significant difference could be observed with respect to cases with ≥Grade 2 postinterventional aortic regurgitation (8% vs. 12.9%; P = 0.5294). Major vascular complications (4% vs. 3.7%; P = ns), 30-day mortality (8% vs. 7.7%; P = ns), and major stroke (3.8% vs. 2%; P = ns) were not different between the 2 groups.
  
  
  CONCLUSIONS
  Despite the technical challenges, procedural results with the 31 mm self-expanding CoreValve prosthesis in large anatomies were similar to those with the smaller sized 29 mm version of the device. However, postinterventional pacemaker rates were significantly higher in the 31 mm cohort despite comparable implantation depths, which might be the result of the specific design of the device.
authors.affiliation: Department of Cardiology, Angiology, Pulmonology, Heidelberg University Hospital, Heidelberg, Germany.
authors.forename: Marie-Isabel
authors.initials: MI
authors.lastname: Murray
authors.forename: Nicolas
authors.initials: N
authors.lastname: Geis
authors.forename: Sven T
authors.initials: ST
authors.lastname: Pleger
authors.forename: Hugo A
authors.initials: HA
authors.lastname: Katus
authors.forename: Raffi
authors.initials: R
authors.lastname: Bekeredjian
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Chorianopoulos
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000033:anatomy & histology*; D001022:Aortic Valve Insufficiency / Q000601:surgery; D001705:Bioprosthesis; D005260:Female; D006801:Humans; D008297:Male; D011474:Prosthesis Design; D019919:Prosthesis Implantation; D012189:Retrospective Studies; D016896:Treatment Outcome