Comparative Quantitative Aortographic Assessment of Regurgitation in Patients Treated With VitaFlow Transcatheter Heart Valve vs. Other Self-Expanding Systems

Rutao Wang; Hideyuki Kawashima; Chao Gao; Fangjun Mou; Ping Li; Junjie Zhang; Jian Yang; Jianfang Luo; Darren Mylotte; William Wijns; Yoshinobu Onuma; Osama Soliman; Ling Tao; Patrick W Serruys

doi:10.3389/fcvm.2021.747174

Comparative Quantitative Aortographic Assessment of Regurgitation in Patients Treated With VitaFlow Transcatheter Heart Valve vs. Other Self-Expanding Systems

Front Cardiovasc Med. 2022 Jan 25:8:747174. doi: 10.3389/fcvm.2021.747174. eCollection 2021.

Authors

Rutao Wang^{1

2

3}, Hideyuki Kawashima^{2

4}, Chao Gao^{1

2

3}, Fangjun Mou¹, Ping Li⁵, Junjie Zhang⁶, Jian Yang⁷, Jianfang Luo⁸, Darren Mylotte², William Wijns^{2

9}, Yoshinobu Onuma², Osama Soliman², Ling Tao¹, Patrick W Serruys^{2

10}

Affiliations

¹ Department of Cardiology, Xijing Hospital, Xi'an, China.
² Department of Cardiology, CORRIB Research Center for Advanced Imaging and Core Laboratory, National University of Ireland, NUIG, Galway, Ireland.
³ Department of Cardiology, Radboud University Medical Center, Nijmegen, Netherlands.
⁴ Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands.
⁵ Department of Cardiology, Yulin First People's Hospital, The Sixth Affiliated Hospital of Guangxi Medical University, Yulin, China.
⁶ Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China.
⁷ Department of Cardiovascular Surgery, Xijing Hospital, Xi'an, China.
⁸ Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
⁹ The Lambe Institute for Translational Medicine and Curam, National University of Ireland Galway (NUIG), Galway, Ireland.
¹⁰ Department of Cardiology, Imperial College London, London, United Kingdom.

Abstract

Objectives: To compare the quantitative angiographic aortic regurgitation (AR) of six self-expanding valves after transcatheter aortic valve replacement (TAVR).

Background: Quantitative videodensitometric aortography (LVOT-AR) is an accurate and reproducible tool for assessment of AR following TAVR.

Methods: This is a retrospective central core-lab analysis of 1,257 consecutive cine aortograms performed post-TAVR. The study included 107 final aortograms of consecutive patients who underwent TAVR with first-generation VitaFlow in four Chinese centers and 1,150 aortograms with five other transcatheter aortic valves (Evolut Pro, Evolut R, CoreValve, Venus A-Valve, and Acurate Neo). LVOT-AR analyses of these five valves were retrieved from a previously published pooled database.

Results: Among 172 aortograms of patients treated with VitaFlow, 107 final aortograms (62.2%) were analyzable by LVOT-AR. In this first in man eight cases necessitated a procedural valve in valve due to inappropriate TAVR positioning and severe aortic paravalvular regurgitation. In the VitaFlow group, the mean LVOT-AR of the intermediate aortograms was 7.3 ± 7.8% and the incidence of LVOT-AR >17% was 8.6%. The mean LVOT-AR of the final aortogram was 6.1 ± 6.4% in the VitaFlow group, followed by Evolut Pro (7.3 ± 6.5%), Evolut R (7.9 ± 7.4%), Venus A-valve (8.9 ± 10.0%), Acurate Neo (9.6 ± 9.2%), and lastly CoreValve (13.7 ± 10.7%) (analysis of variance p < 0.001). Post hoc 2-by-2 testing showed that CoreValve had significantly higher LVOT-AR compared with each of the other five THVs. No statistical difference in LVOT-AR was observed between VitaFlow, Evolut Pro, Evolut R, Acurate Neo, and Venus A-valves. The VitaFlow system had the lowest proportion of patients with LVOT-AR >17% (4.7%) (AR after the final aortograms), followed by Evolut Pro (5.3%), Evolut R (8.8%), Acurate Neo (11.3%), Venus A-valve (14.2%), and CoreValve (30.1%) (chi-square p < 0.001).

Conclusion: Compared to other commercially available self-expanding valves, VitaFlow seems to have a low degree of AR and a low proportion of patients with ≥moderate/severe AR as assessed by quantitative videodensitometric angiography. Once the learning phase is completed, comparisons of AR between different transcatheter heart valves should be attempted in a prospective randomized trial.

Keywords: VitaFlow; aortic stenosis; paravalvular regurgitation; self-expanding valve; transcatheter aortic valve replacement; transcatheter heart valve.