Comparison of paravalvular aortic leak characteristics in the Medtronic CoreValve versus Edwards Sapien Valve: Paravalvular aortic leak characteristics

Olivia N. Gilbert, Charles H. Choi, Jodie L. Franzil, Melissa Caughey, Waqas Qureshi, R. Brandon Stacey, Min Pu, Robert J. Applegate, Sanjay K. Gandhi, David X.M. Zhao

Research output: Contribution to journalArticlepeer-review

8 Scopus citations

Abstract

Objectives: Temporally quantify and localize paravalvular aortic leak (PVL) after transcatheter aortic valve replacement (TAVR) in the Medtronic CoreValve (MCV) versus the Edwards Sapien Valve (ESV). Background: In order to increase the precision of THV selection and PVL intervention, an understanding of PVL characteristics is essential. Methods: The frequency, severity, and location of post-TAVR PVL were evaluated with transthoracic echocardiography pre-discharge, one month, and one-year post-procedure in 202 patients receiving a MCV (N = 120) or ESV (N = 81). This was done through application of a clock face to the short axis of the aortic valve in order to divide the area into three tertiles. Results: Pre-discharge differences between PVL frequency and severity in the MCV and ESV lost significance over time. Localizing these trends, MCV PVL frequency and severity significantly decreased in the first and third tertiles during most time periods while PVL in the second tertile of the MCV or in any of the tertiles of the ESV failed to improve. Presence of pre-discharge PVL was predictive of 30-day HF readmission and/or death (OR = 3.16, 95% CI: 0.99–10.12). Presence of pre-discharge and 30-day PVL was predictive of 1-year HF readmissions and/or death (OR = 2.12, 95% CI: 1.09–4.13 and OR = 1.99, 95% CI: 0.96–4.12). Conclusions: When comparing the MCV and ESV, not all locations of PVL improve equally over time, which has implications for heart failure readmissions. This could be used to influence valve selection and to identify cases in which earlier intervention on PVL may be appropriate.

Original languageEnglish (US)
Pages (from-to)972-980
Number of pages9
JournalCatheterization and Cardiovascular Interventions
Volume92
Issue number5
DOIs
StatePublished - Nov 1 2018
Externally publishedYes

Keywords

  • aortic repair
  • aortic valve disease
  • endovascular
  • transcatheter valve implantation

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

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