title: Differences in Frame Geometry Between Balloon-expandable and Self-expanding Transcatheter Heart Valves and Association With Aortic Regurgitation.
abstract: OBJECTIVE
  Patient- and procedure-related factors are known to be associated with aortic regurgitation after transcatheter aortic valve implantation. Nevertheless, this entity may also be caused by a specific device-host interaction due to the biomechanical properties of the valves, independently of clinical factors. We sought to elucidate the role of frame geometry in the occurrence of aortic regurgitation after Medtronic CoreValve and Edwards SAPIEN valve implantation.
  
  
  METHODS
  We conducted an observational study encompassing 134 patients undergoing transcatheter aortic valve implantation with the Medtronic CoreValve and Edwards SAPIEN valve. Frame analysis was performed at 3 predefined levels of both valves by rotational angiography using dedicated motion compensation software. A distinction was made between patients with no-to-mild and moderate-to-severe aortic regurgitation by echocardiography.
  
  
  RESULTS
  Baseline characteristics were similar between the 2 valves. Despite greater use of predilation in the CoreValve (95.2% vs 82.0%; P=.012), more oversizing (perimeter, 114±7% vs 103±7%; P<.001), and the same depth of implantation (noncoronary sinus, 7±4 vs 8±2mm; left coronary sinus, 8±4 vs 8±2mm), it was less expanded and more eccentric than the Edwards SAPIEN (83±7% vs 92±4%; P<.001 and 82±8% vs 95±3%; P<.001, respectively) and when eccentricity was adjusted for the patient's annulus eccentricity (4±13% vs 21±11%; P<.001). Eccentricity and adjusted eccentricity were associated with moderate-to-severe aortic regurgitation.
  
  
  CONCLUSIONS
  Independently of patient- and procedure-related factors, there is a device-specific device-host interaction that explains aortic regurgitation after transcatheter aortic valve implantation.
authors.affiliation: Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Ramón
authors.initials: R
authors.lastname: Rodríguez-Olivares
authors.affiliation: Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Zouhair
authors.initials: Z
authors.lastname: Rahhab
authors.affiliation: Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Nahid El
authors.initials: NE
authors.lastname: Faquir
authors.affiliation: Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Ben
authors.initials: B
authors.lastname: Ren
authors.affiliation: Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Marcel
authors.initials: M
authors.lastname: Geleijnse
authors.affiliation: Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Nico
authors.initials: N
authors.lastname: Bruining
authors.affiliation: Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Nicolas M
authors.initials: NM
authors.lastname: van Mieghem
authors.affiliation: Department of Cardiology, Royal Perth Hospital Campus, School of Medicine and Pharmacology, University of Western Australia, Crawley, Australia.
authors.forename: Carl
authors.initials: C
authors.lastname: Schultz
authors.affiliation: Siemens Healthcare GmbH, Forchheim, Germany.
authors.forename: Guenter
authors.initials: G
authors.lastname: Lauritsch
authors.affiliation: Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands. Electronic address: p.dejaegere@erasmusmc.nl.
authors.forename: Peter P T
authors.initials: PP
authors.lastname: de Jaegere
mesh_terms: D000792:Angiography; D001022:Aortic Valve Insufficiency / Q000175:diagnosis / Q000209:etiology*; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000601:surgery*; D004868:Equipment Failure; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis; D006801:Humans; D021621:Imaging, Three-Dimensional; D061330:Multidetector Computed Tomography; D011183:Postoperative Complications; D011446:Prospective Studies; D011474:Prosthesis Design; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D065467:Transcatheter Aortic Valve Replacement / Q000009:adverse effects* / Q000295:instrumentation*; D016896:Treatment Outcome
keywords: Angiografía rotacional; Aortic valve stenosis; Estenosis valvular aórtica; Rotational angiography; Sustitución percutánea de válvula aórtica; Transcatheter aortic valve replacement