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Transcatheter aortic valve implantation and its impact on mitral valve geometry and function


Meyer, Alexander; Greve, Dustin; Unbehaun, Axel; Kofler, Markus; Kukucka, Marian; Klein, Christoph; Knierim, Jan; Emmert, Maximilian Y; Falk, Volkmar; Kempfert, Jörg; Sündermann, Simon H (2020). Transcatheter aortic valve implantation and its impact on mitral valve geometry and function. Journal of Cardiac Surgery, 35(9):2185-2193.

Abstract

BACKGROUND

The aim of this study was to evaluate the impact of transcatheter aortic valve implantation (TAVI) on mitral valve geometry and function.

METHODS

Eighty-four patients underwent TAVI. Forty-four (52%) patients received a balloon-expandable valve and 40 (48%) were implanted with a self-expandable valve. All patients underwent three-dimensional-volumetric transesophageal echocardiography of the mitral valve before and immediately after TAVI. A dedicated software was used for assisted semiautomatic measurement of mitral annular geometry.

RESULTS

During systole, the anterior to posterior (AP) diameter was significantly reduced after the procedure (3.4 ± 0.5 cm vs 3.2 ± 0.5 cm; P < .05). The mitral annular area (10.8 ± 2.8cm$^{2}$ vs 9.9 ± 2.6cm$^{2}$ ; P < .05) as well as the tenting area (1.6 ± 0.7 cm$^{2}$ vs 1.2 ± 0.6 cm$^{2}$ ; P < .001) measured at mid-systole were reduced after TAVI. Diastolic measures were similar. Patients treated with balloon-expandable valves showed a significantly larger reduction in the AP diameter compared to self-expandable valves (-0.25 cm vs -0.11 cm; P < .05). The reduction of the annular area was higher in the balloon-expandable group (-1.2 ± 1.59 vs -0.22 ± 1.41; P < .05). Grade of mitral regurgitation did improve or remained stable after TAVI.

CONCLUSION

TAVI significantly impacts the mitral valve and mitral annular geometry and morphology. The choice of the prosthesis (balloon- vs self-expandable) may be relevant for those changes.

Abstract

BACKGROUND

The aim of this study was to evaluate the impact of transcatheter aortic valve implantation (TAVI) on mitral valve geometry and function.

METHODS

Eighty-four patients underwent TAVI. Forty-four (52%) patients received a balloon-expandable valve and 40 (48%) were implanted with a self-expandable valve. All patients underwent three-dimensional-volumetric transesophageal echocardiography of the mitral valve before and immediately after TAVI. A dedicated software was used for assisted semiautomatic measurement of mitral annular geometry.

RESULTS

During systole, the anterior to posterior (AP) diameter was significantly reduced after the procedure (3.4 ± 0.5 cm vs 3.2 ± 0.5 cm; P < .05). The mitral annular area (10.8 ± 2.8cm$^{2}$ vs 9.9 ± 2.6cm$^{2}$ ; P < .05) as well as the tenting area (1.6 ± 0.7 cm$^{2}$ vs 1.2 ± 0.6 cm$^{2}$ ; P < .001) measured at mid-systole were reduced after TAVI. Diastolic measures were similar. Patients treated with balloon-expandable valves showed a significantly larger reduction in the AP diameter compared to self-expandable valves (-0.25 cm vs -0.11 cm; P < .05). The reduction of the annular area was higher in the balloon-expandable group (-1.2 ± 1.59 vs -0.22 ± 1.41; P < .05). Grade of mitral regurgitation did improve or remained stable after TAVI.

CONCLUSION

TAVI significantly impacts the mitral valve and mitral annular geometry and morphology. The choice of the prosthesis (balloon- vs self-expandable) may be relevant for those changes.

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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > Institute for Regenerative Medicine (IREM)
Dewey Decimal Classification:610 Medicine & health
Scopus Subject Areas:Health Sciences > Surgery
Health Sciences > Pulmonary and Respiratory Medicine
Health Sciences > Cardiology and Cardiovascular Medicine
Language:English
Date:September 2020
Deposited On:16 Feb 2021 12:33
Last Modified:17 Feb 2021 21:01
Publisher:Wiley-Blackwell Publishing, Inc.
ISSN:0886-0440
OA Status:Hybrid
Free access at:Publisher DOI. An embargo period may apply.
Publisher DOI:https://doi.org/10.1111/jocs.14734
PubMed ID:32652711

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