Commissural Alignment in SAPIEN 3 Valves: Impact on Gradient and Mortality at Follow-Up

IF 2.1 3区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Catheterization and Cardiovascular Interventions Pub Date : 2025-01-26 DOI:10.1002/ccd.31418

Leire Unzue, Belén Díaz Antón, Adrián Peláez Laderas, Lorena Martín Polo, Jose María Castellano Vázquez, Francisco José Rodríguez Rodrigo, Francisco Javier Parra Jimenez, Leticia Fernández-Friera, Rodrigo Teijeiro Mestre, Eulogio García Fernández

{"title":"Commissural Alignment in SAPIEN 3 Valves: Impact on Gradient and Mortality at Follow-Up","authors":"Leire Unzue, Belén Díaz Antón, Adrián Peláez Laderas, Lorena Martín Polo, Jose María Castellano Vázquez, Francisco José Rodríguez Rodrigo, Francisco Javier Parra Jimenez, Leticia Fernández-Friera, Rodrigo Teijeiro Mestre, Eulogio García Fernández","doi":"10.1002/ccd.31418","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Background</h3>\n \n <p>Commissural misalignment (CMA) has demonstrated to difficult future coronary access in self-expandable prosthesis and has been related with subclinical leaflet thrombosis and a potential increase in valve gradients and aortic regurgitation at follow-up.</p>\n </section>\n \n <section>\n \n <h3> Aims</h3>\n \n <p>The aim of our study was to assess the commissural alignment of the balloon expandable SAPIEN 3 valve (Edwards Lifesciences) and to evaluate its impact on transvalvular gradient and mortality at 5 years of follow-up.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>Consecutive patients treated with SAPIEN 3 prosthesis guided with intraprocedural transesophageal echocardiogram (TEE) with a minimal follow-up of 5 years were included. Commissural alignment between the prosthesis and the native valve was measured by TEE by two independent cardiologists using a standardized 3-cusp view pre and post-valve deployment. CMA was defined as a neocommissure deviation > 30° compared with native commissures. Echocardiographic gradients and clinical events were recorded during follow-up and compared between groups.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>One hundred and five patients (54% male, mean age 80.4 years) were included; 63 (40%) were classified as “aligned” (CMA < 30°) and 42 (60%) as “misaligned” (CMA > 30°). Patients with CMA > 30° presented smaller aortic annulus (23.8 vs. 20.7, <i>p</i> < 0.01) and received smaller valves. There was a slight increase of mean transvalvular gradient during follow-up (9.2−10.3 mmHg, <i>p</i> < 0.05), without significant differences between groups. Mortality rate was 16.2% at 1 year and 49.5% at 5 years; and not related to commissural alignment.</p>\n </section>\n \n <section>\n \n <h3> Conclusions</h3>\n \n <p>Significant CMA is present in 40% of patients treated with SAPIEN 3 valves, however, we didn't find a significant association between CMA and gradient increase or mortality during long-term follow-up.</p>\n </section>\n </div>","PeriodicalId":9650,"journal":{"name":"Catheterization and Cardiovascular Interventions","volume":"105 5","pages":"1067-1076"},"PeriodicalIF":2.1000,"publicationDate":"2025-01-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Catheterization and Cardiovascular Interventions","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1002/ccd.31418","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}

引用次数: 0

Abstract

Background

Commissural misalignment (CMA) has demonstrated to difficult future coronary access in self-expandable prosthesis and has been related with subclinical leaflet thrombosis and a potential increase in valve gradients and aortic regurgitation at follow-up.

Aims

The aim of our study was to assess the commissural alignment of the balloon expandable SAPIEN 3 valve (Edwards Lifesciences) and to evaluate its impact on transvalvular gradient and mortality at 5 years of follow-up.

Methods

Consecutive patients treated with SAPIEN 3 prosthesis guided with intraprocedural transesophageal echocardiogram (TEE) with a minimal follow-up of 5 years were included. Commissural alignment between the prosthesis and the native valve was measured by TEE by two independent cardiologists using a standardized 3-cusp view pre and post-valve deployment. CMA was defined as a neocommissure deviation > 30° compared with native commissures. Echocardiographic gradients and clinical events were recorded during follow-up and compared between groups.

Results

One hundred and five patients (54% male, mean age 80.4 years) were included; 63 (40%) were classified as “aligned” (CMA < 30°) and 42 (60%) as “misaligned” (CMA > 30°). Patients with CMA > 30° presented smaller aortic annulus (23.8 vs. 20.7, p < 0.01) and received smaller valves. There was a slight increase of mean transvalvular gradient during follow-up (9.2−10.3 mmHg, p < 0.05), without significant differences between groups. Mortality rate was 16.2% at 1 year and 49.5% at 5 years; and not related to commissural alignment.

Conclusions

Significant CMA is present in 40% of patients treated with SAPIEN 3 valves, however, we didn't find a significant association between CMA and gradient increase or mortality during long-term follow-up.

查看原文本刊更多论文

求助全文

约1分钟内获得全文求助全文

来源期刊

Catheterization and Cardiovascular Interventions 医学-心血管系统

CiteScore

5.40

自引率

8.70%

发文量

419

审稿时长

2 months

期刊介绍： Catheterization and Cardiovascular Interventions is an international journal covering the broad field of cardiovascular diseases. Subject material includes basic and clinical information that is derived from or related to invasive and interventional coronary or peripheral vascular techniques. The journal focuses on material that will be of immediate practical value to physicians providing patient care in the clinical laboratory setting. To accomplish this, the journal publishes Preliminary Reports and Work In Progress articles that complement the traditional Original Studies, Case Reports, and Comprehensive Reviews. Perspective and insight concerning controversial subjects and evolving technologies are provided regularly through Editorial Commentaries furnished by members of the Editorial Board and other experts. Articles are subject to double-blind peer review and complete editorial evaluation prior to any decision regarding acceptability.