Abstract
Background Surgical aortic valve replacement (SAVR) is nowadays discussed whether it remains
the gold standard of treatment. In the last decade, there has been a tremendous increase
in transcatheter aortic valve implantation (TAVI) due to the growing expertise and
excellent results of the catheter-based approach. We, therefore, retrospectively compared
the rapid deployment valve (RDV), the Edwards Intuity valve (IEV), with the Edwards
Sapien 3 (S3V) with regard to post-procedural hemodynamics.
Methods A total of 246 patients treated with TAVI or SAVR between February 2009 and November
2015 were included. One-hundred twenty-five patients were analyzed in the SAVR group
and compared with 121 patients undergoing TAVI. Transvalvular pressure gradients (PGs)
and the incidence and extent of aortic regurgitation (AR) were compared post-procedurally
by echocardiography for each valve size. In vitro hemodynamics were analyzed by placing
both valves into an aortic silicone phantom connected to a pulsatile flow pump and
measured using phase-contrast magnetic resonance imaging (4D flow MRI).
Results Post-procedurally, mean transvalvular PGs for the 23 mm valves were 9 (7;11.5) versus
13 (9;18) (p < 0.001), whereas maximum PGs were 16.5 (14;22) versus 25.5 mm Hg (17.5;34) (p < 0.001) in IEV and S3V patients, respectively. The 21 mm IEV showed significantly
lower transvalvular PGs compared with the 23 mm S3V: mean PGs: 11 (8;13) versus 13
(9;18) (p < 0.05); maximum PG: 19.5 (13;24) versus 25.5 (18;34) mm Hg (p < 0.05). Analysis revealed significantly lower post-procedural transvalvular PGs
for larger valves sizes. With respect to AR, the incidence of AR was significantly
lower in IEV group (p < 0.05). In vitro velocities and turbulent kinetic energy values showed similar results
between both valves.
Conclusion Implanted RDVs presented a lower incidence of paravalvular regurgitation and were
associated with significantly lower post-procedural transvalvular PGs, especially
for small valve sizes. Our data might support the application of rapid deployment
aortic valves in patients with small aortic annulus in the TAVI era.
Keyword
echocardiography - heart valve - transapical - percutaneous - TAVI - heart valve surgery