Transcatheter aortic valve implantation in patients with an extremely small native aortic annulus: The OCEAN-TAVI registry

Fumiaki Yashima, Masanori Yamamoto, Makoto Tanaka, Ryo Yanagisawa, Takahide Arai, Hideyuki Shimizu, Keiichi Fukuda, Yusuke Watanabe, Toru Naganuma, Shinichi Shirai, Motoharu Araki, Norio Tada, Futoshi Yamanaka, Kentaro Hayashida

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Background Transcatheter aortic valve implantation (TAVI) has been reported to be advantageous over surgical aortic valve replacement owing to the low incidence of prosthesis-patient mismatch (PPM) and large effective orifice area (EOA). However, data on TAVI for extremely small annuli are limited. The present study aimed to compare post-procedural hemodynamics and morphology between 20-mm and 23-mm Sapien XT (SXT) transcatheter heart valves (THVs) with extremely small annuli (< 314 mm2). Methods All patients with severe aortic stenosis treated with TAVI at eight Japanese centers between October 2013 and January 2016 were prospectively included in the Optimized CathEter vAlvular iNtervention (OCEAN-TAVI) registry. In the overall cohort of 20-mm (19 patients) and 23-mm SXTs (492 patients) with extremely small annuli, the patient groups were matched one-to-one using propensity scores, and post-procedural echocardiography and multidetector computed tomography data were compared for 18 matched patients from each group (matched cohort). Results In the matched cohort, the mean gradient was higher (15.4 ± 4.1 vs. 12.2 ± 4.8 mm Hg, p = 0.04), EOA was lower (1.22 ± 0.25 vs. 1.44 ± 0.37 cm2, p = 0.02) and THV area was lower (245.6 ± 19.1 vs. 298.5 ± 33.3 mm2, p < 0.01) in the 20-mm group than in the 23-mm group. However, all patients in both groups were asymptomatic. Although moderate PPM was more prevalent in the 20-mm group than in the 23-mm group (31.6% vs. 7.9%, p < 0.01), the incidence of severe PPM was low and similar between the groups (0% vs. 0.4%, p = 1.00) in the overall cohort. Conclusion A 20-mm SXT in patients who require a small bioprosthesis leads to favorable short-term outcomes.

Original languageEnglish
Pages (from-to)126-131
Number of pages6
JournalInternational Journal of Cardiology
Volume240
DOIs
Publication statusPublished - 2017 Aug 1

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Registries
Prostheses and Implants
Heart Valves
Research Design
Transcatheter Aortic Valve Replacement
Bioprosthesis
Propensity Score
Multidetector Computed Tomography
Aortic Valve Stenosis
Incidence
Aortic Valve
Surgical Instruments
Echocardiography
Catheters
Hemodynamics

Keywords

  • Aortic stenosis
  • Prosthesis-patient mismatch
  • Small annulus
  • Transcatheter aortic valve implantation

ASJC Scopus subject areas

  • Medicine(all)
  • Cardiology and Cardiovascular Medicine

Cite this

Transcatheter aortic valve implantation in patients with an extremely small native aortic annulus : The OCEAN-TAVI registry. / Yashima, Fumiaki; Yamamoto, Masanori; Tanaka, Makoto; Yanagisawa, Ryo; Arai, Takahide; Shimizu, Hideyuki; Fukuda, Keiichi; Watanabe, Yusuke; Naganuma, Toru; Shirai, Shinichi; Araki, Motoharu; Tada, Norio; Yamanaka, Futoshi; Hayashida, Kentaro.

In: International Journal of Cardiology, Vol. 240, 01.08.2017, p. 126-131.

Research output: Contribution to journalArticle

Yashima, F, Yamamoto, M, Tanaka, M, Yanagisawa, R, Arai, T, Shimizu, H, Fukuda, K, Watanabe, Y, Naganuma, T, Shirai, S, Araki, M, Tada, N, Yamanaka, F & Hayashida, K 2017, 'Transcatheter aortic valve implantation in patients with an extremely small native aortic annulus: The OCEAN-TAVI registry', International Journal of Cardiology, vol. 240, pp. 126-131. https://doi.org/10.1016/j.ijcard.2017.01.076
Yashima, Fumiaki ; Yamamoto, Masanori ; Tanaka, Makoto ; Yanagisawa, Ryo ; Arai, Takahide ; Shimizu, Hideyuki ; Fukuda, Keiichi ; Watanabe, Yusuke ; Naganuma, Toru ; Shirai, Shinichi ; Araki, Motoharu ; Tada, Norio ; Yamanaka, Futoshi ; Hayashida, Kentaro. / Transcatheter aortic valve implantation in patients with an extremely small native aortic annulus : The OCEAN-TAVI registry. In: International Journal of Cardiology. 2017 ; Vol. 240. pp. 126-131.
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abstract = "Background Transcatheter aortic valve implantation (TAVI) has been reported to be advantageous over surgical aortic valve replacement owing to the low incidence of prosthesis-patient mismatch (PPM) and large effective orifice area (EOA). However, data on TAVI for extremely small annuli are limited. The present study aimed to compare post-procedural hemodynamics and morphology between 20-mm and 23-mm Sapien XT (SXT) transcatheter heart valves (THVs) with extremely small annuli (< 314 mm2). Methods All patients with severe aortic stenosis treated with TAVI at eight Japanese centers between October 2013 and January 2016 were prospectively included in the Optimized CathEter vAlvular iNtervention (OCEAN-TAVI) registry. In the overall cohort of 20-mm (19 patients) and 23-mm SXTs (492 patients) with extremely small annuli, the patient groups were matched one-to-one using propensity scores, and post-procedural echocardiography and multidetector computed tomography data were compared for 18 matched patients from each group (matched cohort). Results In the matched cohort, the mean gradient was higher (15.4 ± 4.1 vs. 12.2 ± 4.8 mm Hg, p = 0.04), EOA was lower (1.22 ± 0.25 vs. 1.44 ± 0.37 cm2, p = 0.02) and THV area was lower (245.6 ± 19.1 vs. 298.5 ± 33.3 mm2, p < 0.01) in the 20-mm group than in the 23-mm group. However, all patients in both groups were asymptomatic. Although moderate PPM was more prevalent in the 20-mm group than in the 23-mm group (31.6{\%} vs. 7.9{\%}, p < 0.01), the incidence of severe PPM was low and similar between the groups (0{\%} vs. 0.4{\%}, p = 1.00) in the overall cohort. Conclusion A 20-mm SXT in patients who require a small bioprosthesis leads to favorable short-term outcomes.",
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T1 - Transcatheter aortic valve implantation in patients with an extremely small native aortic annulus

T2 - The OCEAN-TAVI registry

AU - Yashima, Fumiaki

AU - Yamamoto, Masanori

AU - Tanaka, Makoto

AU - Yanagisawa, Ryo

AU - Arai, Takahide

AU - Shimizu, Hideyuki

AU - Fukuda, Keiichi

AU - Watanabe, Yusuke

AU - Naganuma, Toru

AU - Shirai, Shinichi

AU - Araki, Motoharu

AU - Tada, Norio

AU - Yamanaka, Futoshi

AU - Hayashida, Kentaro

PY - 2017/8/1

Y1 - 2017/8/1

N2 - Background Transcatheter aortic valve implantation (TAVI) has been reported to be advantageous over surgical aortic valve replacement owing to the low incidence of prosthesis-patient mismatch (PPM) and large effective orifice area (EOA). However, data on TAVI for extremely small annuli are limited. The present study aimed to compare post-procedural hemodynamics and morphology between 20-mm and 23-mm Sapien XT (SXT) transcatheter heart valves (THVs) with extremely small annuli (< 314 mm2). Methods All patients with severe aortic stenosis treated with TAVI at eight Japanese centers between October 2013 and January 2016 were prospectively included in the Optimized CathEter vAlvular iNtervention (OCEAN-TAVI) registry. In the overall cohort of 20-mm (19 patients) and 23-mm SXTs (492 patients) with extremely small annuli, the patient groups were matched one-to-one using propensity scores, and post-procedural echocardiography and multidetector computed tomography data were compared for 18 matched patients from each group (matched cohort). Results In the matched cohort, the mean gradient was higher (15.4 ± 4.1 vs. 12.2 ± 4.8 mm Hg, p = 0.04), EOA was lower (1.22 ± 0.25 vs. 1.44 ± 0.37 cm2, p = 0.02) and THV area was lower (245.6 ± 19.1 vs. 298.5 ± 33.3 mm2, p < 0.01) in the 20-mm group than in the 23-mm group. However, all patients in both groups were asymptomatic. Although moderate PPM was more prevalent in the 20-mm group than in the 23-mm group (31.6% vs. 7.9%, p < 0.01), the incidence of severe PPM was low and similar between the groups (0% vs. 0.4%, p = 1.00) in the overall cohort. Conclusion A 20-mm SXT in patients who require a small bioprosthesis leads to favorable short-term outcomes.

AB - Background Transcatheter aortic valve implantation (TAVI) has been reported to be advantageous over surgical aortic valve replacement owing to the low incidence of prosthesis-patient mismatch (PPM) and large effective orifice area (EOA). However, data on TAVI for extremely small annuli are limited. The present study aimed to compare post-procedural hemodynamics and morphology between 20-mm and 23-mm Sapien XT (SXT) transcatheter heart valves (THVs) with extremely small annuli (< 314 mm2). Methods All patients with severe aortic stenosis treated with TAVI at eight Japanese centers between October 2013 and January 2016 were prospectively included in the Optimized CathEter vAlvular iNtervention (OCEAN-TAVI) registry. In the overall cohort of 20-mm (19 patients) and 23-mm SXTs (492 patients) with extremely small annuli, the patient groups were matched one-to-one using propensity scores, and post-procedural echocardiography and multidetector computed tomography data were compared for 18 matched patients from each group (matched cohort). Results In the matched cohort, the mean gradient was higher (15.4 ± 4.1 vs. 12.2 ± 4.8 mm Hg, p = 0.04), EOA was lower (1.22 ± 0.25 vs. 1.44 ± 0.37 cm2, p = 0.02) and THV area was lower (245.6 ± 19.1 vs. 298.5 ± 33.3 mm2, p < 0.01) in the 20-mm group than in the 23-mm group. However, all patients in both groups were asymptomatic. Although moderate PPM was more prevalent in the 20-mm group than in the 23-mm group (31.6% vs. 7.9%, p < 0.01), the incidence of severe PPM was low and similar between the groups (0% vs. 0.4%, p = 1.00) in the overall cohort. Conclusion A 20-mm SXT in patients who require a small bioprosthesis leads to favorable short-term outcomes.

KW - Aortic stenosis

KW - Prosthesis-patient mismatch

KW - Small annulus

KW - Transcatheter aortic valve implantation

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