Early Hemodynamic Results in Patients with Small Aortic Annulus after Aortic Valve Replacement

Pierre Olivier Dionne, Frédéric Poulin, Denis Bouchard, Philippe Genereux, Reda Ibrahim, Raymond Cartier, Yoan Lamarche, Philippe Demers

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Objective Patients with a small aortic annulus (≤21 mm) have an increased risk of patient-prosthesis mismatch after valve replacement. The aim of this study was to compare the early hemodynamic performance of the balloon-expandable transaortic valve implantation Edwards system (SAPIEN) and the sutureless Perceval prostheses. Methods Fifty patients underwent transcatheter aortic valve implantation, and 113 patients underwent sutureless aortic valve replacement. Mean ± SD aortic annulus diameter was 19.7 ± 1 mm, with no significant difference between groups. SAPIEN valve size was 23 mm in 40 patients (80%) and 26 mm in 10 patients (20%). Perceval valve size was small in 45 patients (40%), medium in 62 patients (55%), and large in 6 patients (5%). Transthoracic Doppler echocardiographic images were collected at baseline and before discharge. Results There were no significant difference in predischarge effective orifice area (SAPIEN: 1.5 ± 0.5 cm 2 and Perceval: 1.48 ± 0.34 cm 2, P = 0.58) and indexed effective orifice areas (SAPIEN: 0.93 ± 0.32 cm 2 /m 2 and Perceval: 0.88 ± 0.22 cm 2 /m 2, P = 0.42). Predischarge mean ± SD transaortic gradient was lower with the SAPIEN than with Perceval valves (12 ± 6 and 17 ± 6 mm Hg, respectively, P < 0.001). Rates of moderate and severe prosthesis-patient mismatch were similar (SAPIEN: 44% and 10% and Perceval: 50% and 14%, P = 0.53 and 0.75, respectively). There were no moderate-severe paravalvular leaks. Conclusions Although indexed effective orifice areas were similar, transcatheter aortic valve implantation with the balloon-expandable SAPIEN system yielded lower predischarge transaortic mean gradients than the surgically implanted Perceval, in patients with a small annulus.

Original languageEnglish (US)
Pages (from-to)254-258
Number of pages5
JournalInnovations: Technology and Techniques in Cardiothoracic and Vascular Surgery
Volume12
Issue number4
DOIs
StatePublished - Jul 1 2017
Externally publishedYes

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Aortic Valve
Hemodynamics
Prostheses and Implants

All Science Journal Classification (ASJC) codes

  • Surgery
  • Cardiology and Cardiovascular Medicine

Cite this

Dionne, Pierre Olivier ; Poulin, Frédéric ; Bouchard, Denis ; Genereux, Philippe ; Ibrahim, Reda ; Cartier, Raymond ; Lamarche, Yoan ; Demers, Philippe. / Early Hemodynamic Results in Patients with Small Aortic Annulus after Aortic Valve Replacement. In: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery. 2017 ; Vol. 12, No. 4. pp. 254-258.
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title = "Early Hemodynamic Results in Patients with Small Aortic Annulus after Aortic Valve Replacement",
abstract = "Objective Patients with a small aortic annulus (≤21 mm) have an increased risk of patient-prosthesis mismatch after valve replacement. The aim of this study was to compare the early hemodynamic performance of the balloon-expandable transaortic valve implantation Edwards system (SAPIEN) and the sutureless Perceval prostheses. Methods Fifty patients underwent transcatheter aortic valve implantation, and 113 patients underwent sutureless aortic valve replacement. Mean ± SD aortic annulus diameter was 19.7 ± 1 mm, with no significant difference between groups. SAPIEN valve size was 23 mm in 40 patients (80{\%}) and 26 mm in 10 patients (20{\%}). Perceval valve size was small in 45 patients (40{\%}), medium in 62 patients (55{\%}), and large in 6 patients (5{\%}). Transthoracic Doppler echocardiographic images were collected at baseline and before discharge. Results There were no significant difference in predischarge effective orifice area (SAPIEN: 1.5 ± 0.5 cm 2 and Perceval: 1.48 ± 0.34 cm 2, P = 0.58) and indexed effective orifice areas (SAPIEN: 0.93 ± 0.32 cm 2 /m 2 and Perceval: 0.88 ± 0.22 cm 2 /m 2, P = 0.42). Predischarge mean ± SD transaortic gradient was lower with the SAPIEN than with Perceval valves (12 ± 6 and 17 ± 6 mm Hg, respectively, P < 0.001). Rates of moderate and severe prosthesis-patient mismatch were similar (SAPIEN: 44{\%} and 10{\%} and Perceval: 50{\%} and 14{\%}, P = 0.53 and 0.75, respectively). There were no moderate-severe paravalvular leaks. Conclusions Although indexed effective orifice areas were similar, transcatheter aortic valve implantation with the balloon-expandable SAPIEN system yielded lower predischarge transaortic mean gradients than the surgically implanted Perceval, in patients with a small annulus.",
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Early Hemodynamic Results in Patients with Small Aortic Annulus after Aortic Valve Replacement. / Dionne, Pierre Olivier; Poulin, Frédéric; Bouchard, Denis; Genereux, Philippe; Ibrahim, Reda; Cartier, Raymond; Lamarche, Yoan; Demers, Philippe.

In: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery, Vol. 12, No. 4, 01.07.2017, p. 254-258.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Early Hemodynamic Results in Patients with Small Aortic Annulus after Aortic Valve Replacement

AU - Dionne, Pierre Olivier

AU - Poulin, Frédéric

AU - Bouchard, Denis

AU - Genereux, Philippe

AU - Ibrahim, Reda

AU - Cartier, Raymond

AU - Lamarche, Yoan

AU - Demers, Philippe

PY - 2017/7/1

Y1 - 2017/7/1

N2 - Objective Patients with a small aortic annulus (≤21 mm) have an increased risk of patient-prosthesis mismatch after valve replacement. The aim of this study was to compare the early hemodynamic performance of the balloon-expandable transaortic valve implantation Edwards system (SAPIEN) and the sutureless Perceval prostheses. Methods Fifty patients underwent transcatheter aortic valve implantation, and 113 patients underwent sutureless aortic valve replacement. Mean ± SD aortic annulus diameter was 19.7 ± 1 mm, with no significant difference between groups. SAPIEN valve size was 23 mm in 40 patients (80%) and 26 mm in 10 patients (20%). Perceval valve size was small in 45 patients (40%), medium in 62 patients (55%), and large in 6 patients (5%). Transthoracic Doppler echocardiographic images were collected at baseline and before discharge. Results There were no significant difference in predischarge effective orifice area (SAPIEN: 1.5 ± 0.5 cm 2 and Perceval: 1.48 ± 0.34 cm 2, P = 0.58) and indexed effective orifice areas (SAPIEN: 0.93 ± 0.32 cm 2 /m 2 and Perceval: 0.88 ± 0.22 cm 2 /m 2, P = 0.42). Predischarge mean ± SD transaortic gradient was lower with the SAPIEN than with Perceval valves (12 ± 6 and 17 ± 6 mm Hg, respectively, P < 0.001). Rates of moderate and severe prosthesis-patient mismatch were similar (SAPIEN: 44% and 10% and Perceval: 50% and 14%, P = 0.53 and 0.75, respectively). There were no moderate-severe paravalvular leaks. Conclusions Although indexed effective orifice areas were similar, transcatheter aortic valve implantation with the balloon-expandable SAPIEN system yielded lower predischarge transaortic mean gradients than the surgically implanted Perceval, in patients with a small annulus.

AB - Objective Patients with a small aortic annulus (≤21 mm) have an increased risk of patient-prosthesis mismatch after valve replacement. The aim of this study was to compare the early hemodynamic performance of the balloon-expandable transaortic valve implantation Edwards system (SAPIEN) and the sutureless Perceval prostheses. Methods Fifty patients underwent transcatheter aortic valve implantation, and 113 patients underwent sutureless aortic valve replacement. Mean ± SD aortic annulus diameter was 19.7 ± 1 mm, with no significant difference between groups. SAPIEN valve size was 23 mm in 40 patients (80%) and 26 mm in 10 patients (20%). Perceval valve size was small in 45 patients (40%), medium in 62 patients (55%), and large in 6 patients (5%). Transthoracic Doppler echocardiographic images were collected at baseline and before discharge. Results There were no significant difference in predischarge effective orifice area (SAPIEN: 1.5 ± 0.5 cm 2 and Perceval: 1.48 ± 0.34 cm 2, P = 0.58) and indexed effective orifice areas (SAPIEN: 0.93 ± 0.32 cm 2 /m 2 and Perceval: 0.88 ± 0.22 cm 2 /m 2, P = 0.42). Predischarge mean ± SD transaortic gradient was lower with the SAPIEN than with Perceval valves (12 ± 6 and 17 ± 6 mm Hg, respectively, P < 0.001). Rates of moderate and severe prosthesis-patient mismatch were similar (SAPIEN: 44% and 10% and Perceval: 50% and 14%, P = 0.53 and 0.75, respectively). There were no moderate-severe paravalvular leaks. Conclusions Although indexed effective orifice areas were similar, transcatheter aortic valve implantation with the balloon-expandable SAPIEN system yielded lower predischarge transaortic mean gradients than the surgically implanted Perceval, in patients with a small annulus.

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