Transcatheter Aortic Valve Replacement With Different Valve Types in Elliptic Aortic Annuli.
The aim of this study was to determine the influence of an elliptic annulus on acute device success rates following self-expanding (SE) transcatheter aortic valve replacement (TAVR) vs. balloon-expandable (BE) TAVR.



Outcomes were assessed using Valve Academic Research Consortium-2 definitions. Aortic annulus ratio (AAR) was measured as short axis diameter/long axis diameter. Mean AAR was 0.81±0.06. Patients were therefore divided into 2 groups: AAR <0.82 and AAR ≥0.82. For circular annuli (AAR ≥0.82; 363 patients), high device success rates were achieved in both valve groups (SE valve, 90.5% vs. BE valve, 95.0%, P=0.14). Conversely, for AAR <0.82 (374 patients), SE valves had lower device success rates than BE valves (82.5% vs. 95.3%, P=0.002). For elliptic annuli, SE-TAVR was an independent predictor of unsuccessful device implantation (OR, 6.34, P<0.001). Nonetheless, increased oversizing of SE valves for elliptic annuli was associated with an exponential rise in device success (threshold ≥17.5%; area under the curve, 0.83) but not for BE-TAVR. Furthermore, optimally oversized SE valves and BE valves had a similarly high device success for elliptic annuli (SE valve, 96.2% vs. BE valve, 95.3%).



For circular annuli, similarly high device success was achieved for the 2 valve types. Conversely, for elliptic annuli, SE valves had a lower device success than BE valves. Device success following optimal oversizing of SE valves, however, was similar to that for BE valves.
Cedars-Sinai Medical Center, Heart Institute.
Yoshio
Y
Maeno
Cedars-Sinai Medical Center, Heart Institute.
Yigal
Y
Abramowitz
Cedars-Sinai Medical Center, Heart Institute.
Sung-Han
SH
Yoon
Cedars-Sinai Medical Center, Heart Institute.
Hasan
H
Jilaihawi
Cedars-Sinai Medical Center, Heart Institute.
Sharma
S
Raul
Cedars-Sinai Medical Center, Heart Institute.
Sharjeel
S
Israr
Cedars-Sinai Medical Center, Heart Institute.
Masaki
M
Miyasaka
Cedars-Sinai Medical Center, Heart Institute.
Hiroyuki
H
Kawamori
Cedars-Sinai Medical Center, Heart Institute.
Yoshio
Y
Kazuno
Cedars-Sinai Medical Center, Heart Institute.
Tanya
T
Rami
Cedars-Sinai Medical Center, Heart Institute.
Nobuyuki
N
Takahashi
Cedars-Sinai Medical Center, Heart Institute.
Geeteshwar
G
Mangat
Cedars-Sinai Medical Center, Heart Institute.
Mohammad
M
Kashif
Cedars-Sinai Medical Center, Heart Institute.
Tarun
T
Chakravarty
Cedars-Sinai Medical Center, Heart Institute.
Mamoo
M
Nakamura
Cedars-Sinai Medical Center, Heart Institute.
Wen
W
Cheng
Cedars-Sinai Medical Center, Heart Institute.
Raj R
RR
Makkar
D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000601:surgery; D058385:Cardiac Valve Annuloplasty / Q000379:methods*; D005260:Female; D006350:Heart Valve Prosthesis; D006801:Humans; D008297:Male; D065467:Transcatheter Aortic Valve Replacement / Q000379:methods*
Device success; Elliptic annulus; Transcatheter aortic valve implantation; Transcatheter aortic valve replacement