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Published on: May 21, 2017
Blood Flow Dynamics of Self-expanding vs Balloon-expandable Transcatheter Aortic Valve Replacement in Patients With a
Takeshi Hamaya1, Kiwamu Kamiya1, Toshiyuki Nagai1
1Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo-city, Hokkaido, Japan.
Background:
A recent trial showed the supra-annular self-expanding valve (SEV) provides superior valve function compared to the balloon-expandable valve (BEV) in patients with aortic stenosis (AS) and a small aortic annulus (SAA) undergoing transcatheter aortic valve replacement (TAVR). This study aimed to compare blood flow hemodynamics between SEV and BEV using four-dimensional flow cardiovascular magnetic resonance imaging (4D flow CMR).
Methods:
We prospectively examined 166 consecutive patients with AS who underwent TAVR between May 2018 and March 2025. SAA was defined as an annular area ≤ 430 mm2. Patients were categorized into four groups: SAA-SEV (n = 35), SAA-BEV (n = 66), non-SAA-SEV (n = 21), and non-SAA-BEV (n = 44). Blood flow patterns, wall shear stress (WSS), and energy loss were assessed using 4D flow CMR.
Results:
In patients with SAA, the SEV group showed significantly greater absolute reductions in vortical flow, helical flow, and flow eccentricity after TAVR compared to the BEV group (-0.47 ± 0.9 vs. 0.15 ± 1.0, P = 0.003; -0.79 ± 0.8 vs. -0.36 ± 0.9, P = 0.008; and -0.59 ± 0.9 vs. -0.20 ± 0.8, P = 0.024, respectively). The absolute reduction of average WSS was also significantly greater in the SEV group (-2.0 [-3.0 to -0.9] Pa vs. -0.9 [-2.5 to 0.4] Pa, P = 0.037). These differences were not observed in the non-SAA groups.
Conclusions:
In SAA patients undergoing TAVR, SEV demonstrated a significantly greater reduction in abnormal blood flow patterns and average WSS than BEV.
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