title: Relationship of Annular Sizing Using Multidetector Computed Tomographic Imaging and Clinical Outcomes After Self-Expanding CoreValve Transcatheter Aortic Valve Replacement.
abstract: Multidetector computed tomography is useful for determining the appropriate transcatheter heart valve (THV) size in patients with severe aortic stenosis who are suboptimal surgical candidates. The relationship between adherence to the recommended CoreValve sizing algorithm and clinical outcomes is not known.
  
  
  
  We evaluated 1023 patients with severe aortic stenosis deemed high or extreme risk for surgery treated with the CoreValve THV. All patients underwent preprocedural multidetector computed tomography, and the scans were reviewed at a central analysis center using standardized software. Compliance to a recommended sizing algorithm was used to identify patients with below-range, in-range, and above-range THV sizing. A device annular sizing ratio (DAR) was also calculated based on the native annulus perimeter and perimeter of the selected THV. Clinical end points included the presence of paravalvular aortic regurgitation evaluated by an independent echocardiographic laboratory. Adherence to the sizing algorithm was highest with a 31-mm THV (92.6%) and lowest with the 23-mm THV (38.5%). Below-range sizing was associated with a higher rate of moderate or severe paravalvular aortic regurgitation (15.3%) than in-range (6.5%) or above-range (10.0%; P<0.001) sizing. Higher DARs were associated with lower rates of moderate or severe paravalvular aortic regurgitation: DAR ≤10%, 17.6%; DAR 10% to 15%, 9.9%; DAR 15% to 20%, 6.3%; and DAR >20%, 4.9%; P<0.001. There was no increase in clinical events associated with higher DARs.
  
  
  
  Adherence to a sizing algorithm guided by multidetector computed tomography resulted in lower rates of paravalvular aortic regurgitation after self-expanding transcatheter valve replacement without an increase in complications.
  
  
  
  URL: http://www.clinicaltrials.gov. Unique identifier: NCT01240902.
authors.affiliation: From the Departments of Internal Medicine (Cardiovascular Division) and Surgery (Cardiovascular Surgery) of the Beth Israel Deaconess Medical Center, Boston, MA (J.J.P., D.S.P.); Division of Cardiac Surgery, University of Pittsburgh Medical Center, PA (T.G.G.); Riverside Medical Center, Columbus, OH (S.J.Y.); Duke University Medical Center, Durham, NC (J.K.H.); Yale University Medical Center, New Haven, CT (J.K.F.); Pinnacle Health Care, Harrisburg, PA (B.M.); Lenox Hill Medical Center, New York, NY (C.E.R.); Department of Medicine-Cardiovascular Medicine, Case Western Reserve, Cleveland, OH (M.C.); Departments of Medicine (J.R.) and Surgery (J. Conte), Johns Hopkins Medical Center, Baltimore, MD; Division of Cardiac Surgery, Ohio State University, Columbus (J. Crestanello); Statistical Services, Medtronic, Inc, Minneapolis, MN (Y.C.); Department of Cardiovascular Diseases, Mayo Clinic Medical Center, Rochester, MN (J.K.O.); Houston Methodist DeBakey Heart & Vascular Center, TX (M.J.R.); and Department of Cardiovascular Surgery, Mount Sinai Medical Center, New York (D.H.A.). jpopma@bidmc.harvard.edu.
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Popma
authors.affiliation: From the Departments of Internal Medicine (Cardiovascular Division) and Surgery (Cardiovascular Surgery) of the Beth Israel Deaconess Medical Center, Boston, MA (J.J.P., D.S.P.); Division of Cardiac Surgery, University of Pittsburgh Medical Center, PA (T.G.G.); Riverside Medical Center, Columbus, OH (S.J.Y.); Duke University Medical Center, Durham, NC (J.K.H.); Yale University Medical Center, New Haven, CT (J.K.F.); Pinnacle Health Care, Harrisburg, PA (B.M.); Lenox Hill Medical Center, New York, NY (C.E.R.); Department of Medicine-Cardiovascular Medicine, Case Western Reserve, Cleveland, OH (M.C.); Departments of Medicine (J.R.) and Surgery (J. Conte), Johns Hopkins Medical Center, Baltimore, MD; Division of Cardiac Surgery, Ohio State University, Columbus (J. Crestanello); Statistical Services, Medtronic, Inc, Minneapolis, MN (Y.C.); Department of Cardiovascular Diseases, Mayo Clinic Medical Center, Rochester, MN (J.K.O.); Houston Methodist DeBakey Heart & Vascular Center, TX (M.J.R.); and Department of Cardiovascular Surgery, Mount Sinai Medical Center, New York (D.H.A.).
authors.forename: Thomas G
authors.initials: TG
authors.lastname: Gleason
authors.affiliation: From the Departments of Internal Medicine (Cardiovascular Division) and Surgery (Cardiovascular Surgery) of the Beth Israel Deaconess Medical Center, Boston, MA (J.J.P., D.S.P.); Division of Cardiac Surgery, University of Pittsburgh Medical Center, PA (T.G.G.); Riverside Medical Center, Columbus, OH (S.J.Y.); Duke University Medical Center, Durham, NC (J.K.H.); Yale University Medical Center, New Haven, CT (J.K.F.); Pinnacle Health Care, Harrisburg, PA (B.M.); Lenox Hill Medical Center, New York, NY (C.E.R.); Department of Medicine-Cardiovascular Medicine, Case Western Reserve, Cleveland, OH (M.C.); Departments of Medicine (J.R.) and Surgery (J. Conte), Johns Hopkins Medical Center, Baltimore, MD; Division of Cardiac Surgery, Ohio State University, Columbus (J. Crestanello); Statistical Services, Medtronic, Inc, Minneapolis, MN (Y.C.); Department of Cardiovascular Diseases, Mayo Clinic Medical Center, Rochester, MN (J.K.O.); Houston Methodist DeBakey Heart & Vascular Center, TX (M.J.R.); and Department of Cardiovascular Surgery, Mount Sinai Medical Center, New York (D.H.A.).
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Yakubov
authors.affiliation: From the Departments of Internal Medicine (Cardiovascular Division) and Surgery (Cardiovascular Surgery) of the Beth Israel Deaconess Medical Center, Boston, MA (J.J.P., D.S.P.); Division of Cardiac Surgery, University of Pittsburgh Medical Center, PA (T.G.G.); Riverside Medical Center, Columbus, OH (S.J.Y.); Duke University Medical Center, Durham, NC (J.K.H.); Yale University Medical Center, New Haven, CT (J.K.F.); Pinnacle Health Care, Harrisburg, PA (B.M.); Lenox Hill Medical Center, New York, NY (C.E.R.); Department of Medicine-Cardiovascular Medicine, Case Western Reserve, Cleveland, OH (M.C.); Departments of Medicine (J.R.) and Surgery (J. Conte), Johns Hopkins Medical Center, Baltimore, MD; Division of Cardiac Surgery, Ohio State University, Columbus (J. Crestanello); Statistical Services, Medtronic, Inc, Minneapolis, MN (Y.C.); Department of Cardiovascular Diseases, Mayo Clinic Medical Center, Rochester, MN (J.K.O.); Houston Methodist DeBakey Heart & Vascular Center, TX (M.J.R.); and Department of Cardiovascular Surgery, Mount Sinai Medical Center, New York (D.H.A.).
authors.forename: J Kevin
authors.initials: JK
authors.lastname: Harrison
authors.affiliation: From the Departments of Internal Medicine (Cardiovascular Division) and Surgery (Cardiovascular Surgery) of the Beth Israel Deaconess Medical Center, Boston, MA (J.J.P., D.S.P.); Division of Cardiac Surgery, University of Pittsburgh Medical Center, PA (T.G.G.); Riverside Medical Center, Columbus, OH (S.J.Y.); Duke University Medical Center, Durham, NC (J.K.H.); Yale University Medical Center, New Haven, CT (J.K.F.); Pinnacle Health Care, Harrisburg, PA (B.M.); Lenox Hill Medical Center, New York, NY (C.E.R.); Department of Medicine-Cardiovascular Medicine, Case Western Reserve, Cleveland, OH (M.C.); Departments of Medicine (J.R.) and Surgery (J. Conte), Johns Hopkins Medical Center, Baltimore, MD; Division of Cardiac Surgery, Ohio State University, Columbus (J. Crestanello); Statistical Services, Medtronic, Inc, Minneapolis, MN (Y.C.); Department of Cardiovascular Diseases, Mayo Clinic Medical Center, Rochester, MN (J.K.O.); Houston Methodist DeBakey Heart & Vascular Center, TX (M.J.R.); and Department of Cardiovascular Surgery, Mount Sinai Medical Center, New York (D.H.A.).
authors.forename: John K
authors.initials: JK
authors.lastname: Forrest
authors.affiliation: From the Departments of Internal Medicine (Cardiovascular Division) and Surgery (Cardiovascular Surgery) of the Beth Israel Deaconess Medical Center, Boston, MA (J.J.P., D.S.P.); Division of Cardiac Surgery, University of Pittsburgh Medical Center, PA (T.G.G.); Riverside Medical Center, Columbus, OH (S.J.Y.); Duke University Medical Center, Durham, NC (J.K.H.); Yale University Medical Center, New Haven, CT (J.K.F.); Pinnacle Health Care, Harrisburg, PA (B.M.); Lenox Hill Medical Center, New York, NY (C.E.R.); Department of Medicine-Cardiovascular Medicine, Case Western Reserve, Cleveland, OH (M.C.); Departments of Medicine (J.R.) and Surgery (J. Conte), Johns Hopkins Medical Center, Baltimore, MD; Division of Cardiac Surgery, Ohio State University, Columbus (J. Crestanello); Statistical Services, Medtronic, Inc, Minneapolis, MN (Y.C.); Department of Cardiovascular Diseases, Mayo Clinic Medical Center, Rochester, MN (J.K.O.); Houston Methodist DeBakey Heart & Vascular Center, TX (M.J.R.); and Department of Cardiovascular Surgery, Mount Sinai Medical Center, New York (D.H.A.).
authors.forename: Brijeshwar
authors.initials: B
authors.lastname: Maini
authors.affiliation: From the Departments of Internal Medicine (Cardiovascular Division) and Surgery (Cardiovascular Surgery) of the Beth Israel Deaconess Medical Center, Boston, MA (J.J.P., D.S.P.); Division of Cardiac Surgery, University of Pittsburgh Medical Center, PA (T.G.G.); Riverside Medical Center, Columbus, OH (S.J.Y.); Duke University Medical Center, Durham, NC (J.K.H.); Yale University Medical Center, New Haven, CT (J.K.F.); Pinnacle Health Care, Harrisburg, PA (B.M.); Lenox Hill Medical Center, New York, NY (C.E.R.); Department of Medicine-Cardiovascular Medicine, Case Western Reserve, Cleveland, OH (M.C.); Departments of Medicine (J.R.) and Surgery (J. Conte), Johns Hopkins Medical Center, Baltimore, MD; Division of Cardiac Surgery, Ohio State University, Columbus (J. Crestanello); Statistical Services, Medtronic, Inc, Minneapolis, MN (Y.C.); Department of Cardiovascular Diseases, Mayo Clinic Medical Center, Rochester, MN (J.K.O.); Houston Methodist DeBakey Heart & Vascular Center, TX (M.J.R.); and Department of Cardiovascular Surgery, Mount Sinai Medical Center, New York (D.H.A.).
authors.forename: Carlos E
authors.initials: CE
authors.lastname: Ruiz
authors.affiliation: From the Departments of Internal Medicine (Cardiovascular Division) and Surgery (Cardiovascular Surgery) of the Beth Israel Deaconess Medical Center, Boston, MA (J.J.P., D.S.P.); Division of Cardiac Surgery, University of Pittsburgh Medical Center, PA (T.G.G.); Riverside Medical Center, Columbus, OH (S.J.Y.); Duke University Medical Center, Durham, NC (J.K.H.); Yale University Medical Center, New Haven, CT (J.K.F.); Pinnacle Health Care, Harrisburg, PA (B.M.); Lenox Hill Medical Center, New York, NY (C.E.R.); Department of Medicine-Cardiovascular Medicine, Case Western Reserve, Cleveland, OH (M.C.); Departments of Medicine (J.R.) and Surgery (J. Conte), Johns Hopkins Medical Center, Baltimore, MD; Division of Cardiac Surgery, Ohio State University, Columbus (J. Crestanello); Statistical Services, Medtronic, Inc, Minneapolis, MN (Y.C.); Department of Cardiovascular Diseases, Mayo Clinic Medical Center, Rochester, MN (J.K.O.); Houston Methodist DeBakey Heart & Vascular Center, TX (M.J.R.); and Department of Cardiovascular Surgery, Mount Sinai Medical Center, New York (D.H.A.).
authors.forename: Duane S
authors.initials: DS
authors.lastname: Pinto
authors.affiliation: From the Departments of Internal Medicine (Cardiovascular Division) and Surgery (Cardiovascular Surgery) of the Beth Israel Deaconess Medical Center, Boston, MA (J.J.P., D.S.P.); Division of Cardiac Surgery, University of Pittsburgh Medical Center, PA (T.G.G.); Riverside Medical Center, Columbus, OH (S.J.Y.); Duke University Medical Center, Durham, NC (J.K.H.); Yale University Medical Center, New Haven, CT (J.K.F.); Pinnacle Health Care, Harrisburg, PA (B.M.); Lenox Hill Medical Center, New York, NY (C.E.R.); Department of Medicine-Cardiovascular Medicine, Case Western Reserve, Cleveland, OH (M.C.); Departments of Medicine (J.R.) and Surgery (J. Conte), Johns Hopkins Medical Center, Baltimore, MD; Division of Cardiac Surgery, Ohio State University, Columbus (J. Crestanello); Statistical Services, Medtronic, Inc, Minneapolis, MN (Y.C.); Department of Cardiovascular Diseases, Mayo Clinic Medical Center, Rochester, MN (J.K.O.); Houston Methodist DeBakey Heart & Vascular Center, TX (M.J.R.); and Department of Cardiovascular Surgery, Mount Sinai Medical Center, New York (D.H.A.).
authors.forename: Marco
authors.initials: M
authors.lastname: Costa
authors.affiliation: From the Departments of Internal Medicine (Cardiovascular Division) and Surgery (Cardiovascular Surgery) of the Beth Israel Deaconess Medical Center, Boston, MA (J.J.P., D.S.P.); Division of Cardiac Surgery, University of Pittsburgh Medical Center, PA (T.G.G.); Riverside Medical Center, Columbus, OH (S.J.Y.); Duke University Medical Center, Durham, NC (J.K.H.); Yale University Medical Center, New Haven, CT (J.K.F.); Pinnacle Health Care, Harrisburg, PA (B.M.); Lenox Hill Medical Center, New York, NY (C.E.R.); Department of Medicine-Cardiovascular Medicine, Case Western Reserve, Cleveland, OH (M.C.); Departments of Medicine (J.R.) and Surgery (J. Conte), Johns Hopkins Medical Center, Baltimore, MD; Division of Cardiac Surgery, Ohio State University, Columbus (J. Crestanello); Statistical Services, Medtronic, Inc, Minneapolis, MN (Y.C.); Department of Cardiovascular Diseases, Mayo Clinic Medical Center, Rochester, MN (J.K.O.); Houston Methodist DeBakey Heart & Vascular Center, TX (M.J.R.); and Department of Cardiovascular Surgery, Mount Sinai Medical Center, New York (D.H.A.).
authors.forename: Jon
authors.initials: J
authors.lastname: Resar
authors.affiliation: From the Departments of Internal Medicine (Cardiovascular Division) and Surgery (Cardiovascular Surgery) of the Beth Israel Deaconess Medical Center, Boston, MA (J.J.P., D.S.P.); Division of Cardiac Surgery, University of Pittsburgh Medical Center, PA (T.G.G.); Riverside Medical Center, Columbus, OH (S.J.Y.); Duke University Medical Center, Durham, NC (J.K.H.); Yale University Medical Center, New Haven, CT (J.K.F.); Pinnacle Health Care, Harrisburg, PA (B.M.); Lenox Hill Medical Center, New York, NY (C.E.R.); Department of Medicine-Cardiovascular Medicine, Case Western Reserve, Cleveland, OH (M.C.); Departments of Medicine (J.R.) and Surgery (J. Conte), Johns Hopkins Medical Center, Baltimore, MD; Division of Cardiac Surgery, Ohio State University, Columbus (J. Crestanello); Statistical Services, Medtronic, Inc, Minneapolis, MN (Y.C.); Department of Cardiovascular Diseases, Mayo Clinic Medical Center, Rochester, MN (J.K.O.); Houston Methodist DeBakey Heart & Vascular Center, TX (M.J.R.); and Department of Cardiovascular Surgery, Mount Sinai Medical Center, New York (D.H.A.).
authors.forename: John
authors.initials: J
authors.lastname: Conte
authors.affiliation: From the Departments of Internal Medicine (Cardiovascular Division) and Surgery (Cardiovascular Surgery) of the Beth Israel Deaconess Medical Center, Boston, MA (J.J.P., D.S.P.); Division of Cardiac Surgery, University of Pittsburgh Medical Center, PA (T.G.G.); Riverside Medical Center, Columbus, OH (S.J.Y.); Duke University Medical Center, Durham, NC (J.K.H.); Yale University Medical Center, New Haven, CT (J.K.F.); Pinnacle Health Care, Harrisburg, PA (B.M.); Lenox Hill Medical Center, New York, NY (C.E.R.); Department of Medicine-Cardiovascular Medicine, Case Western Reserve, Cleveland, OH (M.C.); Departments of Medicine (J.R.) and Surgery (J. Conte), Johns Hopkins Medical Center, Baltimore, MD; Division of Cardiac Surgery, Ohio State University, Columbus (J. Crestanello); Statistical Services, Medtronic, Inc, Minneapolis, MN (Y.C.); Department of Cardiovascular Diseases, Mayo Clinic Medical Center, Rochester, MN (J.K.O.); Houston Methodist DeBakey Heart & Vascular Center, TX (M.J.R.); and Department of Cardiovascular Surgery, Mount Sinai Medical Center, New York (D.H.A.).
authors.forename: Juan
authors.initials: J
authors.lastname: Crestanello
authors.affiliation: From the Departments of Internal Medicine (Cardiovascular Division) and Surgery (Cardiovascular Surgery) of the Beth Israel Deaconess Medical Center, Boston, MA (J.J.P., D.S.P.); Division of Cardiac Surgery, University of Pittsburgh Medical Center, PA (T.G.G.); Riverside Medical Center, Columbus, OH (S.J.Y.); Duke University Medical Center, Durham, NC (J.K.H.); Yale University Medical Center, New Haven, CT (J.K.F.); Pinnacle Health Care, Harrisburg, PA (B.M.); Lenox Hill Medical Center, New York, NY (C.E.R.); Department of Medicine-Cardiovascular Medicine, Case Western Reserve, Cleveland, OH (M.C.); Departments of Medicine (J.R.) and Surgery (J. Conte), Johns Hopkins Medical Center, Baltimore, MD; Division of Cardiac Surgery, Ohio State University, Columbus (J. Crestanello); Statistical Services, Medtronic, Inc, Minneapolis, MN (Y.C.); Department of Cardiovascular Diseases, Mayo Clinic Medical Center, Rochester, MN (J.K.O.); Houston Methodist DeBakey Heart & Vascular Center, TX (M.J.R.); and Department of Cardiovascular Surgery, Mount Sinai Medical Center, New York (D.H.A.).
authors.forename: Yanping
authors.initials: Y
authors.lastname: Chang
authors.affiliation: From the Departments of Internal Medicine (Cardiovascular Division) and Surgery (Cardiovascular Surgery) of the Beth Israel Deaconess Medical Center, Boston, MA (J.J.P., D.S.P.); Division of Cardiac Surgery, University of Pittsburgh Medical Center, PA (T.G.G.); Riverside Medical Center, Columbus, OH (S.J.Y.); Duke University Medical Center, Durham, NC (J.K.H.); Yale University Medical Center, New Haven, CT (J.K.F.); Pinnacle Health Care, Harrisburg, PA (B.M.); Lenox Hill Medical Center, New York, NY (C.E.R.); Department of Medicine-Cardiovascular Medicine, Case Western Reserve, Cleveland, OH (M.C.); Departments of Medicine (J.R.) and Surgery (J. Conte), Johns Hopkins Medical Center, Baltimore, MD; Division of Cardiac Surgery, Ohio State University, Columbus (J. Crestanello); Statistical Services, Medtronic, Inc, Minneapolis, MN (Y.C.); Department of Cardiovascular Diseases, Mayo Clinic Medical Center, Rochester, MN (J.K.O.); Houston Methodist DeBakey Heart & Vascular Center, TX (M.J.R.); and Department of Cardiovascular Surgery, Mount Sinai Medical Center, New York (D.H.A.).
authors.forename: Jae K
authors.initials: JK
authors.lastname: Oh
authors.affiliation: From the Departments of Internal Medicine (Cardiovascular Division) and Surgery (Cardiovascular Surgery) of the Beth Israel Deaconess Medical Center, Boston, MA (J.J.P., D.S.P.); Division of Cardiac Surgery, University of Pittsburgh Medical Center, PA (T.G.G.); Riverside Medical Center, Columbus, OH (S.J.Y.); Duke University Medical Center, Durham, NC (J.K.H.); Yale University Medical Center, New Haven, CT (J.K.F.); Pinnacle Health Care, Harrisburg, PA (B.M.); Lenox Hill Medical Center, New York, NY (C.E.R.); Department of Medicine-Cardiovascular Medicine, Case Western Reserve, Cleveland, OH (M.C.); Departments of Medicine (J.R.) and Surgery (J. Conte), Johns Hopkins Medical Center, Baltimore, MD; Division of Cardiac Surgery, Ohio State University, Columbus (J. Crestanello); Statistical Services, Medtronic, Inc, Minneapolis, MN (Y.C.); Department of Cardiovascular Diseases, Mayo Clinic Medical Center, Rochester, MN (J.K.O.); Houston Methodist DeBakey Heart & Vascular Center, TX (M.J.R.); and Department of Cardiovascular Surgery, Mount Sinai Medical Center, New York (D.H.A.).
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Reardon
authors.affiliation: From the Departments of Internal Medicine (Cardiovascular Division) and Surgery (Cardiovascular Surgery) of the Beth Israel Deaconess Medical Center, Boston, MA (J.J.P., D.S.P.); Division of Cardiac Surgery, University of Pittsburgh Medical Center, PA (T.G.G.); Riverside Medical Center, Columbus, OH (S.J.Y.); Duke University Medical Center, Durham, NC (J.K.H.); Yale University Medical Center, New Haven, CT (J.K.F.); Pinnacle Health Care, Harrisburg, PA (B.M.); Lenox Hill Medical Center, New York, NY (C.E.R.); Department of Medicine-Cardiovascular Medicine, Case Western Reserve, Cleveland, OH (M.C.); Departments of Medicine (J.R.) and Surgery (J. Conte), Johns Hopkins Medical Center, Baltimore, MD; Division of Cardiac Surgery, Ohio State University, Columbus (J. Crestanello); Statistical Services, Medtronic, Inc, Minneapolis, MN (Y.C.); Department of Cardiovascular Diseases, Mayo Clinic Medical Center, Rochester, MN (J.K.O.); Houston Methodist DeBakey Heart & Vascular Center, TX (M.J.R.); and Department of Cardiovascular Surgery, Mount Sinai Medical Center, New York (D.H.A.).
authors.forename: David H
authors.initials: DH
authors.lastname: Adams
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D001021:Aortic Valve / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000000981:diagnostic imaging / Q000209:etiology; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery; D000066491:Clinical Decision-Making; D003661:Decision Support Techniques; D005260:Female; D019983:Guideline Adherence; D006350:Heart Valve Prosthesis / Q000592:standards; D006801:Humans; D008297:Male; D061330:Multidetector Computed Tomography; D018579:Patient Selection; D017410:Practice Guidelines as Topic; D011237:Predictive Value of Tests; D011474:Prosthesis Design / Q000592:standards; D012307:Risk Factors; D012720:Severity of Illness Index; D065467:Transcatheter Aortic Valve Replacement / Q000009:adverse effects / Q000295:instrumentation* / Q000592:standards; D016896:Treatment Outcome; D014481:United States
keywords: annular geometry; aortic regurgitation; aortic stenosis; multidetector CT imaging; transcatheter aortic valve; valvular heart disease