title: Predictors of High Post-Procedural Gradients after Catheter-Based Aortic Valve Implantation Using Direct Flow Medical Bioprostheses.
abstract: The Direct Flow Medical (DFM) valve is a new non-metallic and repositionable bioprosthesis used for transcatheter aortic valve implantation (TAVI). The study aim was to investigate procedural and post-implant valve data in patients receiving differently sized DFM bioprostheses.
  
  
  
  Procedural, echocardiographic and computed tomography findings of 28 patients receiving either a 25, 27 or 29 mm DFM bioprosthesis were analyzed.
  
  
  
  Implantation of a 29 mm bioprosthesis was associated with longer procedure (p <0.05) and radiation (p <0.05) times, and a higher dose-area product (p <0.01) compared to the 25 mm valve. A high mean post-interventional aortic gradient indicating a suboptimal result was found in 44% patients receiving a 29 mm bioprosthesis, whereas none of the patients with a 25 or 27 mm valve had a high gradient (p <0.05). Aortic valve calcification was greatest in the 29 mm group and correlated with a higher dose-area product (p <0.01).
  
  
  
  DFM bioprosthesis size significantly influences the TAVI procedure and post-implant valve function. Valve calcification and use of the 29 mm DFM bioprosthesis per se possibly predict a more complicated procedure. Therefore, annulus size and valve calcification severity should be taken into consideration when deciding which bioprosthesis type might be best suited for individual patients.
authors.affiliation: Department of Cardiology and Pulmonary Medicine, University Medical Center Göttingen, Göttingen, Germany.
authors.forename: Frauke S
authors.initials: FS
authors.lastname: Czepluch
authors.affiliation: Institute for Diagnostic and Interventional Radiology, University Medical Center Göttingen, Göttingen, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Schwarz
authors.affiliation: Department of Cardiology and Pulmonary Medicine, University Medical Center Göttingen, Göttingen, Germany.
authors.forename: Tobias
authors.initials: T
authors.lastname: Tichelbäcker
authors.affiliation: Institute for Diagnostic and Interventional Radiology, University Medical Center Göttingen, Göttingen, Germany.
authors.forename: Joachim
authors.initials: J
authors.lastname: Lotz
authors.affiliation: Department of Cardiology and Pulmonary Medicine, University Medical Center Göttingen, Göttingen, Germany.
authors.forename: Gerd
authors.initials: G
authors.lastname: Hasenfuss
authors.affiliation: Department of Cardiology and Pulmonary Medicine, University Medical Center Göttingen, Göttingen, Germany.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Schillinger
authors.affiliation: Department of Cardiology and Pulmonary Medicine, University Medical Center Göttingen, Göttingen, Germany. Electronic correspondence: jacobshagen@med.uni-goettingen.de.
authors.forename: Claudius
authors.initials: C
authors.lastname: Jacobshagen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000473:pathology* / Q000503:physiopathology / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D001705:Bioprosthesis; D002114:Calcinosis / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D004452:Echocardiography; D005260:Female; D006350:Heart Valve Prosthesis; D006439:Hemodynamics; D006801:Humans; D008297:Male; D061330:Multidetector Computed Tomography; D061646:Operative Time; D011474:Prosthesis Design; D011829:Radiation Dosage; D000069079:Radiation Exposure; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D065467:Transcatheter Aortic Valve Replacement / Q000009:adverse effects / Q000295:instrumentation*; D016896:Treatment Outcome