Impact of "high" implantation on functionality of self-expandable bioprosthesis during the short- and long-term outcome of patients who undergo transcatheter aortic valve implantation: Is high implantation beneficial?

Abstract

Aim: High position of the self-expandable bioprosthesis CoreValve/Evolut R has been proved to affect immediate hemodynamics of the valve. Whether this may have any impact on long-term procedural outcome has not been defined yet. The purpose of this study was to assess whether the final position of aortic bioprosthesis affects its long-term functionality.

Method: Consecutive patients (pts) who underwent successful TAVI procedure were evaluated and separated into 2 groups according to the implantation depth (ID): Group I: pts with 4 mm <ID ≤13 mm; Group II: pts with ID ≤4 mm. ID was measured utilizing the final aortography after device delivery and was defined as the distance both from the native non- and left coronary cusp to the deepest edge of the deployed bioprosthesis in the left ventricle. Clinical outcome and echocardiographic parameters were recorded before the procedure, at discharge, at 1-month and 1-year-follow-up.

Results: One hundred and ninety-eight pts (80 ± 5.5 years, 107 males [54%]) treated with the CoreValve/Evolut R bioprostheses were recorded. Group I appeared to have higher peak gradient (17 ± 6.5 vs 14 ± 5.5 mm Hg, P = .02) as well as Vmax (2 ± 0.4 vs 1.84 ± 0.38 m/s, P = .02) at follow-up after 1 year when compared with Group II (ID <4 mm). Grouping for ID did not affect all-cause 1-year mortality. Paravalvular aortic regurgitation, as well as LVEF at discharge, proved to be independent predictors of all-cause 1-year mortality when adjusted for cofactors.

Conclusion: Implantation depth under 4 mm seems to have a favorable effect on long-term hemodynamic valve functionality.

Keywords: aortic valve stenosis; implantation depth; transcatheter aortic valve implantation; valve functionality.