Transcatheter Aortic Valve Replacement With Different Valve Types in Elliptic Aortic Annuli

Area of Science:

• Cardiovascular Medicine
• Interventional Cardiology
• Medical Devices

Background:

• Transcatheter aortic valve replacement (TAVR) is a key treatment for aortic stenosis.
• Device success rates can be influenced by patient-specific aortic annulus anatomy.
• The impact of elliptic annuli on TAVR device success requires further investigation.

Purpose of the Study:

• To evaluate the influence of aortic annulus ellipticity on acute device success in self-expanding (SE) versus balloon-expandable (BE) TAVR.
• To compare device success rates between SE-TAVR and BE-TAVR in patients with circular versus elliptic aortic annuli.

Main Methods:

• Aortic annulus ratio (AAR) was calculated (short axis diameter/long axis diameter) to define circular (AAR ≥0.82) and elliptic (AAR <0.82) annuli.
• Device success was assessed using Valve Academic Research Consortium-2 definitions.
• Outcomes for SE-TAVR and BE-TAVR were compared within each annulus group, with further analysis of oversizing effects.

Main Results:

• For circular annuli, both SE and BE valves demonstrated high device success rates (90.5% vs. 95.0%, P=0.14).
• For elliptic annuli, SE valves had significantly lower device success rates than BE valves (82.5% vs. 95.3%, P=0.002).
• Optimal oversizing (≥17.5%) of SE valves for elliptic annuli led to a significant increase in device success, achieving rates comparable to BE valves (96.2% vs. 95.3%).

Conclusions:

• Aortic annulus ellipticity significantly affects SE-TAVR device success.
• While SE-TAVR shows lower success in elliptic annuli, optimal oversizing mitigates this disadvantage.
• Both SE and BE TAVR achieve high device success in elliptic annuli when SE valves are optimally oversized.