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The impact of left ventricular function and balloon aortic valvuloplasty on paravalvular leakage in patients undergoing TAVI.

Session Myocardial function

Speaker Konstantinos Toutouzas

Event : ESC Congress 2015

  • Topic : imaging
  • Sub-topic : Echocardiography: Systolic and Diastolic Function
  • Session type : Moderated Posters

Authors : M Drakopoulou (Athens,GR), K Toutouzas (Athens,GR), G Latsios (Athens,GR), A Synetos (Athens,GR), K Stathogiannis (Athens,GR), A Mastrokostopoulos (Athens,GR), S Yuecel (Bonn,DE), U Gerckens (Bonn,DE), E Grube (Bonn,DE), D Tousoulis (Athens,GR)

Authors:
M. Drakopoulou1 , K. Toutouzas1 , G. Latsios1 , A. Synetos1 , K. Stathogiannis1 , A. Mastrokostopoulos1 , S. Yuecel2 , U. Gerckens2 , E. Grube3 , D. Tousoulis1 , 1Hippokration Hospital, University of Athens, 1st Department of Cardiology - Athens - Greece , 2Gemeinschaftskrankenhaus - Bonn - Germany , 3University Hospital, Dept of Medicine II - Bonn - Germany ,

Citation:
European Heart Journal ( 2015 ) 36 ( Abstract Supplement ), 184

Background: Direct transcatheter aortic valve implantation (TAVI) has shown to be safe and feasible with a comparably success rate to TAVI with prior balloon aortic valvuloplasty (BAV). However, little is known about the impact of direct TAVI on the paravalvular leakage (PVL) of patients based on pre-procedural left ventricular ejection function (LVEF).

Purpose: We sought to evaluate the impact of direct TAVI on the PVL of patients with impaired and patients with preserved ejection fraction.

Methods: Patients with severe and symptomatic aortic stenosis (effective orifice area [EOA]≤1cm2) who were scheduled for TAVI were prospectively enrolled. Prospectively collected echocardiographic data before TAVI were retrospectively analyzed in all patients. The VARC-2 criteria were used for designating clinical outcomes. Patients were classified based on LVEF in patients with impaired (LVEF<50%) and patients with preserved LVEF (≥50%). The VARC-2 criteria were used for designating clinical outcomes.

Results: Two hundred and four patients (mean age: 81±7 years) were included in the study. From 130 patients with preserved LVEF, 62 patients (48%) underwent BAV and 68 patients (52%) underwent direct TAVI. Device success rate was equal between the 2 groups (70% in the BAV group versus 74% in the direct group, p=0.24). The BAV group had higher moderate/severe paravalvular leakage (24% versus 6%, p<0.04) compared to the direct group. From 74 patients with impaired LVEF, 56 patients (70%) underwent BAV and 18 patients (30%) underwent direct TAVI. Device success rate was lower in the BAV compared to the direct TAVI group (70% versus 88%, p=0.04). The BAV group had higher moderate/severe paravalvular leakage (36% versus 6%, p=0.02) compared to the direct group.

Conclusions: Direct TAVI with the self-expanding bioprosthesis is safe and feasible and has lower paravalvular leakage rates comparing to patients undergoing non-direct TAVI at 1-year.

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