title: Comparison of balloon-expandable versus self-expandable valves for transcatheter aortic valve implantation in patients with low-gradient severe aortic stenosis and preserved left ventricular ejection fraction.
abstract: A relevant proportion of patients, classified as severe aortic stenosis on the basis of valve area ≤1 cm(2), have a mean transvalvular gradient ≤40 mm Hg, despite a preserved left ventricular ejection fraction (LGSAS). We assessed the clinical and hemodynamic impact of transcatheter aortic valve implantation in patients with symptomatic LGSAS at high risk for surgery or inoperable, according to the type of percutaneous valve implanted. Ninety-five patients received an Edwards SAPIEN valve (Edwards Lifesciences, Irvine, California) and 51 received a Medtronic CoreValve (Medtronic, Inc., Minneapolis, Minnesota). The hemodynamic performance of the 2 valves was similar in term of final transvalvular gradients (10 mm Hg, p = 0.069). Early mortality rate was 7% and was not different between the 2 valves (p = 0.73). During follow-up, cardiovascular mortality rate was similar between groups, and valve type was not a predictor of outcome (p = 0.72). Estimated survival by Kaplan-Meier at 2 years was 70%. At multivariate analysis, life-threatening or major bleeding, postprocedural aortic insufficiency, and acute kidney injury were the major predictors of an adverse outcome. In patients with LGSAS treated by transcatheter aortic valve implantation, the use of balloon-expandable versus self-expandable valves resulted in similar hemodynamic, early, and long-term clinical outcomes.
authors.affiliation: Division of Cardiology, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy.
authors.forename: Elisa
authors.initials: E
authors.lastname: Covolo
authors.affiliation: Department of Cardiology, Policlinico S. Orsola-Malpighi, University of Bologna, Bologna, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Saia
authors.affiliation: Division of Cardiology, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Napodano
authors.affiliation: Laboratory of Epidemiological Methods and Biostatistics, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy.
authors.forename: Anna Chiara
authors.initials: AC
authors.lastname: Frigo
authors.affiliation: Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Pierfrancesco
authors.initials: P
authors.lastname: Agostoni
authors.affiliation: Division of Cardiology, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Mojoli
authors.affiliation: Division of Cardiology, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Fraccaro
authors.affiliation: Department of Cardiology, Policlinico S. Orsola-Malpighi, University of Bologna, Bologna, Italy.
authors.forename: Cristina
authors.initials: C
authors.lastname: Ciuca
authors.affiliation: Department of Invasive Cardiology, Humanitas Clinical and Research Center, Rozzano, Milan, Italy.
authors.forename: Patrizia
authors.initials: P
authors.lastname: Presbitero
authors.affiliation: Division of Cardiology, Città della Salute e della Scienza, University of Turin, Turin, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Moretti
authors.affiliation: Division of Cardiology, Città della Salute e della Scienza, University of Turin, Turin, Italy.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: D'Ascenzo
authors.affiliation: Division of Cardiology, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy. Electronic address: giuseppe.tarantini.1@gmail.com.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Tarantini
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000175:diagnosis* / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D063126:Balloon Valvuloplasty / Q000379:methods*; D001705:Bioprosthesis; D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis / Q000009:adverse effects; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D065467:Transcatheter Aortic Valve Replacement / Q000379:methods; D014481:United States; D016277:Ventricular Function, Left