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Gallo F, Gallone G, Kim WK, Reifart J, Veulemans V, Zeus T, Toggweiler S, De Backer O, Søndergaard L, De Marco F, Regazzoli D, Reimers B, Muntané-Carol G, Estevez-Loureiro R, Hernandez U, Moscarelli M, Airale L, D'Ascenzo F, Armario X, Mylotte D, Bhadra OD, Conradi L, Donday LAM, Nombela-Franco L, Barbanti M, Reddavid C, Criscione E, Brugaletta S, Nicolini E, Piva T, Tzanis G, Ronco F, Barbierato M, Rodes-Cabau J, Mangieri A, Colombo A, Giannini F. Procedural outcomes of the 34 mm EvolutR Transcatheter valve in a real-world population insights from the HORSE multicenter collaborative registry. Int J Cardiol 2022; 361:55-60. [PMID: 35500820 DOI: 10.1016/j.ijcard.2022.04.079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 04/23/2022] [Accepted: 04/27/2022] [Indexed: 01/07/2023]
Abstract
OBJECTIVES The aim of this study was to evaluate outcomes of real-world patients with aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR) with the 34 mm Evolut R (Medtronic, Minneapolis, Minnesota). BACKGROUND Larger aortic annulus has been associated with increased incidence of paravalvular leaks (PVLs) after TAVR. However, little is known, so far, about the performance of the 34 mm Evolut R in this setting. METHODS From the multicenter, international, retrospective Horizontal Aorta in Transcatheter Self-expanding Valves (HORSE) registry, including patients who underwent TAVR for native severe AS, we selected patients treated with the 34 mm Evolut R evaluating procedural characteristics and VARC-2 defined device success. We also compared 34 mm Evolut R with other Evolut R sizes. RESULTS Among the 4434 patients included in the registry, 572 (13%) received the 34 mm Evolut R valve. Mean age was 80.8 ± 6.5 years and the median STS PROM score was 4 [interquartile range 2-6]. Device success was achieved in 87.4% with 7.7% of PVLs; moreover, the rate of permanent pacemaker implantation (PPMI) was 22.4%. Patients who underwent 34 mm Evolut R implantation experienced more in-hospital permanent pacemaker implantation (22.4% vs. 15%; p < 0.001). At multivariate analysis, 34 mm Evolut R did not affect device success (OR: 0.81 [0.60-1.09]; p = 0.151). Device success was consistent with other THVs sizes (87.4% vs. 89.6%; p = 0.157). CONCLUSIONS THV replacement in patients requiring 34 mm Evolut R has an acceptable performance. Compared to other Medtronic sizes it demonstrated to be comparable in terms of device success, despite an increased rate of pacemaker implantation.
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Affiliation(s)
- Francesco Gallo
- Interventional Cardiology, Department of Cardio-Thoracic and Vascular Sciences, Ospedale dell'Angelo, AULSS3 Serenissima, Mestre, Venezia, Italy
| | - Guglielmo Gallone
- Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
| | - Won-Keun Kim
- Department of Cardiology, Kerckhoff Heart and Thorax Centre, Bad Nauheim, Germany
| | - Jörg Reifart
- Department of Cardiology, Kerckhoff Heart and Thorax Centre, Bad Nauheim, Germany
| | - Verena Veulemans
- Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University, Düsseldorf, Germany
| | - Tobias Zeus
- Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University, Düsseldorf, Germany
| | | | - Ole De Backer
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Lars Søndergaard
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Federico De Marco
- Department of Clinical and Interventional Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | | | - Bernhard Reimers
- Cardio Center, IRCCS Humanitas Research Hospital, Rozzano, Italy
| | | | | | - Ubaldo Hernandez
- Interventional Cardiology Unit, Hospital Álvaro Cunqueiro, Vigo, Spain
| | - Marco Moscarelli
- Department of Cardiovascular Surgery, GVM Care & Research, Bari, Italy
| | - Lorenzo Airale
- Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
| | - Fabrizio D'Ascenzo
- Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
| | - Xavier Armario
- Department of Cardiology, National University of Ireland, Galway, (NUIG), Galway, Ireland
| | - Darren Mylotte
- Department of Cardiology, National University of Ireland, Galway, (NUIG), Galway, Ireland
| | - Oliver Daniel Bhadra
- Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Lenard Conradi
- Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | | | - Luis Nombela-Franco
- Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
| | - Marco Barbanti
- Division of Cardiology, A.O.U. Policlinico-Vittorio Emanuele, Catania, Italy
| | - Claudia Reddavid
- Division of Cardiology, A.O.U. Policlinico-Vittorio Emanuele, Catania, Italy
| | - Enrico Criscione
- Division of Cardiology, A.O.U. Policlinico-Vittorio Emanuele, Catania, Italy
| | - Salvatore Brugaletta
- Cardiovascular Institute, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Elisa Nicolini
- Interventional Cardiology, Ospedali Riuniti di Ancona, Ancona, Italy
| | - Tommaso Piva
- Interventional Cardiology, Ospedali Riuniti di Ancona, Ancona, Italy
| | - Giorgos Tzanis
- Department of Interventional Cardiology, Henry Dunant Hospital Center, Athens, Greece
| | - Federico Ronco
- Interventional Cardiology, Department of Cardio-Thoracic and Vascular Sciences, Ospedale dell'Angelo, AULSS3 Serenissima, Mestre, Venezia, Italy
| | - Marco Barbierato
- Interventional Cardiology, Department of Cardio-Thoracic and Vascular Sciences, Ospedale dell'Angelo, AULSS3 Serenissima, Mestre, Venezia, Italy
| | - Josep Rodes-Cabau
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Antonio Mangieri
- Cardio Center, IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Antonio Colombo
- Cardio Center, IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Francesco Giannini
- Interventional Cardiology Unit, Maria Cecilia Hospital, GVM Care and Research.
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Armijo G, Tang GH, Kooistra N, Ferreira-Neto AN, Toggweiler S, Amat-Santos IJ, Keller LS, Urena M, Ahmad H, Tafur Soto J, Muñoz-Garcia E, Regueiro A, Leenders GE, Tirado-Conte G, Sengupta A, McInerney A, Couture T, Cuevas Herreros O, Rodriguez-Gabella T, Kini A, Ahmed M, Zaid S, Gonzalo N, Nuñez-Gil IJ, Muñoz-Garcia AJ, Jimenez-Quevedo P, Fernández-Ortiz A, Himbert D, Nietlispach F, Stella P, Dangas GD, Escaned J, Macaya C, Rodés-Cabau J, Nombela-Franco L. Third-Generation Balloon and Self-Expandable Valves for Aortic Stenosis in Large and Extra-Large Aortic Annuli From the TAVR-LARGE Registry. Circ Cardiovasc Interv 2020; 13:e009047. [DOI: 10.1161/circinterventions.120.009047] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Currently, 2 third-generation transcatheter valves, 29-mm Sapien-3 and 34-mm Evolut-R (ER), are indicated for large sized aortic annuli. We analyzed short and 1-year performance of these valves in patients with large (area ≥575 mm
2
or perimeter ≥85 mm) and extra-large (≥683 mm
2
or ≥94.2 mm) aortic annuli undergoing transcatheter aortic valve replacement.
Methods:
A total of 833 patients across 12 centers with symptomatic aortic stenosis and large aortic annuli underwent transcatheter aortic valve replacement with 29-mm Sapien-3 (n=640) or 34-mm ER (n=193). Clinical, anatomic, and procedural characteristics were collected, and Valve Academic Research Consortium-2 outcomes were reported.
Results:
Median aortic annulus area and perimeter were 617 mm
2
(591–657) and 89.1 mm (87.0–92.1), respectively (704 mm
2
[689–743] and 96.0 mm [94.5–97.9] in the subgroup of 124 patients with extra-large annuli). Overall device success was 94.3% (Sapien-3, 95.8% and ER, 89.3%;
P
=0.001), with a higher rate of significant paravalvular leak (
P
=0.004), second valve implantation (
P
=0.013), and valve embolization (
P
=0.009) in the ER group. Thirty-day and 1-year mortality was 2.4% and 9.2%, respectively, without differences between groups. Valve hemodynamics were excellent (mean gradient, 8.8±3.6 mm Hg; 3.3% rate of moderate-severe paravalvular leak) in the extra-large annulus, without differences compared with the large annulus group.
Conclusions:
In patients with large and extra-large aortic annuli, transcatheter aortic valve replacement using 29-mm Sapien-3 and 34-mm ER is safe and feasible. Observed differences in clinical outcomes and hemodynamic performance may guide valve choice in this cohort of patients undergoing transcatheter aortic valve replacement.
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Affiliation(s)
- Germán Armijo
- Department of Cardiology, Cardiovascular Institute, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos, Madrid, Spain (G.A., G.T.-C., A.M., N.G., I.J.N.-G., P.J.-Q., A.F.-O., J.E., C.M., L.N.-F.)
| | - Gilbert H.L. Tang
- Department of Cardiovascular Surgery, Mount Sinai Health System, New York, NY (G.H.L.T., A.S.)
| | - Nynke Kooistra
- Department of Cardiology, University Medical Center Utrecht, Utrecht University, the Netherlands (N.K., G.E.L., P.S.)
| | - Alfredo Nunes Ferreira-Neto
- Department of Cardiology, Quebec Heart and Lung Institute, Laval University, Quebec City, Canada (A.N.F.-N., T.C., J.R.-C.)
| | - Stefan Toggweiler
- Department of Cardiology, Heart Center Lucerne, Luzerner Kantonsspital, Switzerland (S.T.)
| | - Ignacio J. Amat-Santos
- Department of Cardiology, Instituto de Ciencias del Corazón, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Hospital Clínico Universitario de Valladolid, Spain (I.J.A.-S., T.R.-G.)
| | - Lukas S. Keller
- Department of Cardiology, University Heart Centre Zurich, Switzerland (L.S.K., O.C.H.)
| | - Marina Urena
- Department of Cardiology, Assistance publique-Hôpitaux de Paris, Bichat Hospital, France (M.U., D.H.)
| | - Hasan Ahmad
- Division of Cardiology, Westchester Medical Center, Valhalla, New York, NY (H.A., S.Z.)
| | - Jose Tafur Soto
- Department of Cardiology, John Ochsner Heart and Vascular Institute, New Orleans, LA (J.T.S., M.A.)
| | - Erika Muñoz-Garcia
- Department of Cardiology, Hospital Clínico Universitario Virgen de la Victoria, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Malaga, Spain (E.M.-G., A.J.M.-G.)
| | - Ander Regueiro
- Department of Cardiology, Hospital Clinic de Barcelona, Institut Clinic Cardiovascular, IDIBAPS, Spain (A.R.)
| | - Geert E. Leenders
- Department of Cardiology, University Medical Center Utrecht, Utrecht University, the Netherlands (N.K., G.E.L., P.S.)
| | - Gabriela Tirado-Conte
- Department of Cardiology, Cardiovascular Institute, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos, Madrid, Spain (G.A., G.T.-C., A.M., N.G., I.J.N.-G., P.J.-Q., A.F.-O., J.E., C.M., L.N.-F.)
| | - Aditya Sengupta
- Department of Cardiovascular Surgery, Mount Sinai Health System, New York, NY (G.H.L.T., A.S.)
| | - Angela McInerney
- Department of Cardiology, Cardiovascular Institute, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos, Madrid, Spain (G.A., G.T.-C., A.M., N.G., I.J.N.-G., P.J.-Q., A.F.-O., J.E., C.M., L.N.-F.)
| | - Thomas Couture
- Department of Cardiology, Quebec Heart and Lung Institute, Laval University, Quebec City, Canada (A.N.F.-N., T.C., J.R.-C.)
| | - Oscar Cuevas Herreros
- Department of Cardiology, University Heart Centre Zurich, Switzerland (L.S.K., O.C.H.)
| | - Tania Rodriguez-Gabella
- Department of Cardiology, Instituto de Ciencias del Corazón, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Hospital Clínico Universitario de Valladolid, Spain (I.J.A.-S., T.R.-G.)
| | - Annapoorna Kini
- Division of Cardiology, Mount Sinai Medical Center, New York, NY (A.K., G.D.D.)
| | - Mohammed Ahmed
- Department of Cardiology, John Ochsner Heart and Vascular Institute, New Orleans, LA (J.T.S., M.A.)
| | - Syed Zaid
- Division of Cardiology, Westchester Medical Center, Valhalla, New York, NY (H.A., S.Z.)
| | - Nieves Gonzalo
- Department of Cardiology, Cardiovascular Institute, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos, Madrid, Spain (G.A., G.T.-C., A.M., N.G., I.J.N.-G., P.J.-Q., A.F.-O., J.E., C.M., L.N.-F.)
| | - Ivan J. Nuñez-Gil
- Department of Cardiology, Cardiovascular Institute, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos, Madrid, Spain (G.A., G.T.-C., A.M., N.G., I.J.N.-G., P.J.-Q., A.F.-O., J.E., C.M., L.N.-F.)
| | - Antonio J. Muñoz-Garcia
- Department of Cardiology, Hospital Clínico Universitario Virgen de la Victoria, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Malaga, Spain (E.M.-G., A.J.M.-G.)
| | - Pilar Jimenez-Quevedo
- Department of Cardiology, Cardiovascular Institute, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos, Madrid, Spain (G.A., G.T.-C., A.M., N.G., I.J.N.-G., P.J.-Q., A.F.-O., J.E., C.M., L.N.-F.)
| | - Antonio Fernández-Ortiz
- Department of Cardiology, Cardiovascular Institute, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos, Madrid, Spain (G.A., G.T.-C., A.M., N.G., I.J.N.-G., P.J.-Q., A.F.-O., J.E., C.M., L.N.-F.)
| | - Dominique Himbert
- Department of Cardiology, Assistance publique-Hôpitaux de Paris, Bichat Hospital, France (M.U., D.H.)
| | - Fabian Nietlispach
- Department of Cardiology, Universitz Hospital Zurich and Hirslanden Klinik Im Park, Zurich, Switzerland (F.N.)
| | - Pieter Stella
- Department of Cardiology, University Medical Center Utrecht, Utrecht University, the Netherlands (N.K., G.E.L., P.S.)
| | - George D. Dangas
- Division of Cardiology, Mount Sinai Medical Center, New York, NY (A.K., G.D.D.)
| | - Javier Escaned
- Department of Cardiology, Cardiovascular Institute, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos, Madrid, Spain (G.A., G.T.-C., A.M., N.G., I.J.N.-G., P.J.-Q., A.F.-O., J.E., C.M., L.N.-F.)
| | - Carlos Macaya
- Department of Cardiology, Cardiovascular Institute, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos, Madrid, Spain (G.A., G.T.-C., A.M., N.G., I.J.N.-G., P.J.-Q., A.F.-O., J.E., C.M., L.N.-F.)
| | - Josep Rodés-Cabau
- Department of Cardiology, Quebec Heart and Lung Institute, Laval University, Quebec City, Canada (A.N.F.-N., T.C., J.R.-C.)
| | - Luis Nombela-Franco
- Department of Cardiology, Cardiovascular Institute, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos, Madrid, Spain (G.A., G.T.-C., A.M., N.G., I.J.N.-G., P.J.-Q., A.F.-O., J.E., C.M., L.N.-F.)
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