Commissural alignment and the ACURATE neo2 transcatheter aortic valve: Impact on valve performance.
Catheter Cardiovasc Interv
; 104(1): 115-124, 2024 Jul.
Article
en En
| MEDLINE
| ID: mdl-38764320
ABSTRACT
BACKGROUND:
Transcatheter aortic valve replacement (TAVR) is increasingly being used to treat severe aortic stenosis in younger patients. Accordingly, lifetime management regarding future reintervention and coronary access is a concern.AIMS:
To assess the impact of commissural alignment on ACURATE neo2 transcatheter aortic valve (TAV) performance.METHODS:
COMALIGN-neo2 was an observational, retrospective study enrolling consecutive TAVR patients treated with the ACURATE neo2 (October 2021 to October 2022). The degree of commissural (mis)-alignment (CMA) with the native aortic valve commissures was determined and transvalvular gradient, effective orifice area, patient-prosthesis mismatch (PPM), and aortic regurgitation (AR) were assessed.RESULTS:
Among 825 patients, the mean age was 80.7 years and 42% were female. Commissural alignment was achieved in 60% of cases; mild (26%), moderate (9%), and severe misalignment (5%) were found less often. Severe PPM occurred more frequently in patients with severe CMA (14.7%) compared to aligned valves (p = 0.034). By multivariate analysis, severe CMA (odds ratio [OR] 3.12, 95% confidence interval [CI] [1.09-8.90]; p = 0.033) and lack of postdilatation (OR 3.85, [1.33-11.1]; p = 0.012) were associated with severe PPM. Higher rates of ≥mild AR (51.4%) were found in TAVs implanted with severe CMA compared to aligned (34.3%), mildly (38.1%) or moderately (36.0%) misaligned TAVs (p = 0.030). Multivariate analysis identified severe CMA (OR 2.05, [1.05-4.02]; p = 0.037) to be an independent predictor of ≥mild AR.CONCLUSIONS:
COMALIGN-neo2 is the largest study to date assessing the impact of commissural alignment on acute TAV performance. Severe CMA with the ACURATE neo2 platform was associated with worse valve hemodynamics and increased risk for mild AR.Palabras clave
Texto completo:
1
Colección:
01-internacional
Base de datos:
MEDLINE
Asunto principal:
Válvula Aórtica
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Insuficiencia de la Válvula Aórtica
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Estenosis de la Válvula Aórtica
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Diseño de Prótesis
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Prótesis Valvulares Cardíacas
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Recuperación de la Función
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Reemplazo de la Válvula Aórtica Transcatéter
/
Hemodinámica
Límite:
Aged
/
Aged80
/
Female
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Humans
/
Male
Idioma:
En
Revista:
Catheter Cardiovasc Interv
Asunto de la revista:
CARDIOLOGIA
Año:
2024
Tipo del documento:
Article
País de afiliación:
Dinamarca
Pais de publicación:
Estados Unidos