title: Impact of underfilling and overfilling in balloon-expandable transcatheter aortic valve implantation assessed by multidetector computed tomography: Insights from the Optimized CathEter vAlvular iNtervention (OCEAN-TAVI) registry.
abstract: BACKGROUND
  Underfilling or overfilling of balloon-expandable transcatheter heart valves (THVs) during transcatheter aortic valve implantation (TAVI) is commonly used to improve conformity to small or calcified annuli in order to avoid serious complications. However, little is known about this technique. This study assessed the effects of underfilling and overfilling of THVs.
  
  
  RESULTS
  Data from 213 consecutive TAVI patients treated with balloon-expandable THVs in 4 Japanese centers between October 2013 and December 2014 were prospectively analyzed; 23-mm and 26-mm THVs were implanted in 96 cases (56 underfilling, 22 nominal filling, and 18 overfilling) and 38 cases (23 underfilling and 15 nominal filling), respectively. Pre/postprocedural multidetector computed tomography (MDCT) and echocardiographic data were compared. MDCT revealed that the minimum area of the underfilled 23-mm THVs was significantly decreased compared to that of nominal filled and overfilled THVs (308.3 SD 26.1 vs. 333.9 SD 14.7 vs. 347.8 SD 21.3mm(2), respectively, p<0.0001); analogous results were demonstrated for underfilled 26-mm THVs compared to nominal filled THVs (386.2 SD 34.6 vs. 423.6 SD 17.3mm(2), respectively, p=0.0004). The postprocedural transvalvular gradient of underfilled 23-mm THVs was significantly higher than that of nominal filled and overfilled THVs, while there were no differences for 26-mm THVs.
  
  
  CONCLUSIONS
  Underfilling or overfilling of THVs is safe and feasible, conforming to the original annulus and covering a continuous range of annular sizes with limited THV size options. However, care should be taken when underfilling 23-mm THVs due to the potential for increased transvalvular gradient.
authors: Department of Cardiology, Keio University School of Medicine, Tokyo, Japan.
authors: Fumiaki
authors: F
authors: Yashima
authors: Department of Cardiology, Toyohashi Heart Center, Aichi, Japan.
authors: Masanori
authors: M
authors: Yamamoto
authors: Department of Cardiology, Teikyo University School of Medicine, Tokyo, Japan.
authors: Yusuke
authors: Y
authors: Watanabe
authors: Department of Cardiology, New Tokyo Hospital, Chiba, Japan.
authors: Kensuke
authors: K
authors: Takagi
authors: Department of Diagnostic Radiology, Keio University School of Medicine, Tokyo, Japan.
authors: Yoshitake
authors: Y
authors: Yamada
authors: Department of Cardiology, Keio University School of Medicine, Tokyo, Japan.
authors: Taku
authors: T
authors: Inohara
authors: Department of Cardiology, Keio University School of Medicine, Tokyo, Japan.
authors: Ryo
authors: R
authors: Yanagisawa
authors: Department of Cardiology, Keio University School of Medicine, Tokyo, Japan.
authors: Makoto
authors: M
authors: Tanaka
authors: Department of Cardiology, Keio University School of Medicine, Tokyo, Japan.
authors: Takahide
authors: T
authors: Arai
authors: Department of Cardiovascular Surgery, Keio University School of Medicine, Tokyo, Japan.
authors: Hideyuki
authors: H
authors: Shimizu
authors: Department of Diagnostic Radiology, Keio University School of Medicine, Tokyo, Japan.
authors: Masahiro
authors: M
authors: Jinzaki
authors: Department of Cardiology, Teikyo University School of Medicine, Tokyo, Japan.
authors: Ken
authors: K
authors: Kozuma
authors: Department of Cardiology, Keio University School of Medicine, Tokyo, Japan.
authors: Keiichi
authors: K
authors: Fukuda
authors: Department of Cardiology, Toyohashi Heart Center, Aichi, Japan.
authors: Takahiko
authors: T
authors: Suzuki
authors: Department of Cardiology, Keio University School of Medicine, Tokyo, Japan. Electronic address: k-hayashida@umin.ac.jp.
authors: Kentaro
authors: K
authors: Hayashida
mesh_terms: D000369:Aged, 80 and over; D001021:Aortic Valve / Q000000981:diagnostic imaging* / Q000601:surgery; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000601:surgery*; D017548:Echocardiography, Transesophageal; D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis; D006801:Humans; D021621:Imaging, Three-Dimensional; D008297:Male; D061330:Multidetector Computed Tomography / Q000379:methods*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011474:Prosthesis Design; D017755:Prosthesis Fitting / Q000379:methods*; D012042:Registries; D012720:Severity of Illness Index; D065467:Transcatheter Aortic Valve Replacement / Q000379:methods*; D016896:Treatment Outcome
keywords: Aortic stenosis; Multidetector computed tomography; Overfilling; Transcatheter aortic valve implantation; Underfilling