Effect of ascending aortic dimension on acute procedural success following self-expanding transcatheter aortic valve replacement: A multicenter retrospective analysis

Yoshio Maeno, Sung Han Yoon, Yigal Abramowitz, Yusuke Watanabe, Hasan Jilaihawi, Mao Shin Lin, Jason Chan, Rahul Sharma, Hideyuki Kawashima, Sharjeel Israr, Hiroyuki Kawamori, Masaki Miyasaka, Tanya Rami, Yoshio Kazuno, Geeteshwar Mangat, Mohammad Kashif, Tarun Chakravarty, Hsien Li Kao, Michael Kang yin Lee, Mamoo NakamuraKen Kozuma, Wen Cheng, Raj R. Makkar

Research output: Contribution to journalArticlepeer-review

9 Scopus citations

Abstract

Aims Self–expanding (SE) valves are characterized with long stent frame design and the radial force of the device exists both in the inflow and outflow level. Therefore, we hypothesized that device success of SE-valves may be influenced by ascending aortic dimensions (AAD). The aim of this study was to determine the influence of AAD on acute device success rates following SE transcatheter aortic valve replacement (TAVR). Methods & Results In 4 centers in the United States and Asia, 214 consecutive patients underwent SE-TAVR. Outcomes were assessed in line with Valve Academic Research Consortium criteria. AAD was defined as the sum of the short and long axis aortic diameter divided by 2. Overall, device success rate was 85.0%. Multivariate analysis revealed that increased AAD (Odds ratio 1.27) and % oversizing (Odds ratio 0.88) were found to be independent predictors of unsuccessful device implantation. The c-statistic of the model for device success was area under the curve 0.79, sensitivity 81.3% and specificity 44.0%. Co-existence of several risk factors was associated with an exponential fall to 64.2% in device success rate. For a large AAD, however, optimally oversized SE-valves (threshold 16.2%) resulted with high device success rates compared to suboptimal oversizing (88.6% vs. 64.2%, p = 0.005). Conclusions Larger AAD and smaller degrees of oversizing were confirmed to be the most relevant predictors of unsuccessful device implantation following SE-valve implantations. Optimal oversizing of great significance was noted, particularly that with a large AAD.

Original languageEnglish
Pages (from-to)100-105
Number of pages6
JournalInternational Journal of Cardiology
Volume244
DOIs
StatePublished - 1 Oct 2017
Externally publishedYes

Keywords

  • Aortic dimensions
  • Device success
  • Oversizing
  • Predictors
  • TAVI
  • TAVR

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