Mid-Term Outcomes of Transcatheter Aortic Valve Replacement in Extremely Large Annuli With Edwards SAPIEN 3 Valve |
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| Affiliation: | 1. Mount Sinai Medical Center, New York, New York;2. Westchester Medical Center, Valhalla, New York;3. Emory University, Atlanta, Georgia;4. Montefiore Medical Center, Bronx, New York;5. Cedars-Sinai Medical Center, Los Angeles, California;6. Brigham and Women’s Hospital, Boston, Massachusetts;7. St. Paul’s Hospital, Vancouver, British Columbia, Canada;8. Virginia Heart, Falls Church, Virginia;9. St. Francis Hospital, Manhasset, New York;10. Inova Medical Group, Falls Church, Virginia;11. University of Washington, Seattle, Washington;12. Columbia University Medical Center, New York, New York;13. Weill Cornell Medical Center, New York, New York;14. Robert Wood Johnson-Barnabas Health System, New Brunswick, New Jersey;15. Mercy General Hospital, Sacramento, California;p. Baylor Scott & White Health System, Plano, Texas;q. Swedish Medical Center, Seattle, Washington;r. Cleveland Clinic, Cleveland, Ohio;s. Marcus Heart Valve Center, Piedmont Atlanta Hospital, Atlanta, Georgia |
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| Abstract: | ObjectivesThe aim of this study was to report the 1-year results of transcatheter aortic valve replacement (TAVR) with the Edwards SAPIEN 3 (S3) valve in extremely large annuli.BackgroundFavorable 30-day outcomes of S3 TAVR in annuli >683 mm2 have previously been reported. Pacemaker implantation rates were acceptable, and a larger left ventricular outflow tract and more eccentric annular anatomy were associated with increasing paravalvular leak.MethodsFrom December 2013 to December 2018, 105 patients across 15 centers with mean area 721.3 ± 36.1 mm2 (range 683.5 to 852.0 mm2) underwent TAVR using an S3 device. Clinical, anatomic, and procedural characteristics were analyzed. One-year survival and echocardiographic follow-up were reached in 94.3% and 82.1% of patients, respectively. Valve Academic Research Consortium-2 30-day and 1-year outcomes were reported.ResultsThe mean age was 76.9 ± 10.4 years, and Society of Thoracic Surgeons predicted risk score averaged 5.2 ± 3.4%. One-year overall mortality and stroke rates were 18.2% and 2.4%, respectively. Quality-of-life index improved from baseline to 30 days and at 1 year (p < 0.001 for both). Mild paravalvular aortic regurgitation occurred in 21.7% of patients, while moderate or greater paravalvular aortic regurgitation occurred in 4.3%. Mild and moderate or severe transvalvular aortic regurgitation occurred in 11.6% and 0%, respectively. Valve gradients remained stable at 1 year.ConclusionsS3 TAVR in annular areas >683 mm2 is feasible, with favorable mid-term outcomes. |
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