PMID- 35862182
OWN - NLM
STAT- MEDLINE
DCOM- 20220810
LR  - 20221212
IS  - 1524-4539 (Electronic)
IS  - 0009-7322 (Linking)
VI  - 146
IP  - 6
DP  - 2022 Aug 9
TI  - Deformation of Transcatheter Aortic Valve Prostheses: Implications for 
      Hypoattenuating Leaflet Thickening and Clinical Outcomes.
PG  - 480-493
LID - 10.1161/CIRCULATIONAHA.121.058339 [doi]
AB  - BACKGROUND: Although transcatheter aortic valve replacement (TAVR) therapy 
      continues to grow, there have been concerns about the occurrence of 
      hypoattenuating leaflet thickening (HALT), which may affect prosthesis function 
      or durability. This study aimed to examine prosthesis frame factors and correlate 
      their extent to the frequency of HALT and clinical outcomes. METHODS: We 
      prospectively examined 565 patients with cardiac computed tomography screening 
      for HALT at 30 days after balloon-expandable SAPIEN3 and self-expanding EVOLUT 
      TAVR. Deformation of the TAVR prostheses, asymmetric prosthesis leaflet 
      expansion, prosthesis sinus volumes, and commissural alignment were analyzed on 
      the postprocedural computed tomography. For descriptive purposes, an index of 
      prosthesis deformation was calculated, with values >1.00 representing relative 
      midsegment underexpansion. A time-to-event model was performed to evaluate the 
      association of HALT with the clinical outcome. RESULTS: Overall, HALT was present 
      in 21% of SAPIEN3 patients and in 16% of EVOLUT patients at 30 days after TAVR. 
      The occurrence of HALT was directly associated with greater prosthesis frame 
      deformation (P<0.001), worse asymmetry of the leaflets (P<0.001), and smaller 
      TAVR neosinus volumes (P<0.001). These relations were present in both prosthetic 
      types and in all of their size ranges (all P<0.05). In multivariable analyses 
      that include clinical variables previously associated with HALT (eg, 
      anticoagulant therapy), variables of TAVR prosthesis deformation remained 
      predictive of HALT. Although HALT was not associated with changes in prosthetic 
      hemodynamics, its presence was associated with the risk of mortality at 1 year, 
      with respect to greater incidences of all-cause mortality (hazard ratio, 2.98 
      [95% CI, 1.57-5.63]; P=0.001), cardiac death (hazard ratio, 4.58 [95% CI, 
      1.81-11.6]; P=0.001), and a composite outcome of all-cause mortality and heart 
      failure hospitalization (hazard ratio, 1.94 [95% CI, 1.14-3.30]; P=0.02) with 
      adjustment for age, sex, and comorbidities. CONCLUSIONS: Nonuniform expansion of 
      TAVR prostheses resulting in frame deformation, asymmetric leaflet, and smaller 
      neosinus volume is related to occurrence of HALT in patients who undergo TAVR. 
      These data may have implications for both prosthesis valve design and deployment 
      techniques to improve clinical outcomes for these patients.
FAU - Fukui, Miho
AU  - Fukui M
AUID- ORCID: 0000-0002-7235-5551
AD  - Cardiovascular Imaging Research Center and Core Laboratory (M.F., G.H., J.L.C.), 
      Minneapolis Heart Institute Foundation, MN.
AD  - Minneapolis Heart Institute at Abbott Northwestern Hospital, MN (M.F., V.N.B., 
      S.G., M.W.D., G.H., H.S., M.G., M.E.-S., J.R.L., J.L.C., P.S.).
FAU - Bapat, Vinayak N
AU  - Bapat VN
AD  - Valve Science Center (V.N.B., S.G., M.W.D., H.S., M.G., M.E.-S., J.R.L., P.S.), 
      Minneapolis Heart Institute Foundation, MN.
AD  - Minneapolis Heart Institute at Abbott Northwestern Hospital, MN (M.F., V.N.B., 
      S.G., M.W.D., G.H., H.S., M.G., M.E.-S., J.R.L., J.L.C., P.S.).
FAU - Garcia, Santiago
AU  - Garcia S
AUID- ORCID: 0000-0002-1806-6783
AD  - Valve Science Center (V.N.B., S.G., M.W.D., H.S., M.G., M.E.-S., J.R.L., P.S.), 
      Minneapolis Heart Institute Foundation, MN.
AD  - Minneapolis Heart Institute at Abbott Northwestern Hospital, MN (M.F., V.N.B., 
      S.G., M.W.D., G.H., H.S., M.G., M.E.-S., J.R.L., J.L.C., P.S.).
FAU - Dworak, Marshall W
AU  - Dworak MW
AUID- ORCID: 0000-0001-6847-2416
AD  - Valve Science Center (V.N.B., S.G., M.W.D., H.S., M.G., M.E.-S., J.R.L., P.S.), 
      Minneapolis Heart Institute Foundation, MN.
AD  - Minneapolis Heart Institute at Abbott Northwestern Hospital, MN (M.F., V.N.B., 
      S.G., M.W.D., G.H., H.S., M.G., M.E.-S., J.R.L., J.L.C., P.S.).
FAU - Hashimoto, Go
AU  - Hashimoto G
AUID- ORCID: 0000-0001-5067-2786
AD  - Cardiovascular Imaging Research Center and Core Laboratory (M.F., G.H., J.L.C.), 
      Minneapolis Heart Institute Foundation, MN.
AD  - Minneapolis Heart Institute at Abbott Northwestern Hospital, MN (M.F., V.N.B., 
      S.G., M.W.D., G.H., H.S., M.G., M.E.-S., J.R.L., J.L.C., P.S.).
FAU - Sato, Hirotomo
AU  - Sato H
AUID- ORCID: 0000-0002-1093-9754
AD  - Valve Science Center (V.N.B., S.G., M.W.D., H.S., M.G., M.E.-S., J.R.L., P.S.), 
      Minneapolis Heart Institute Foundation, MN.
AD  - Minneapolis Heart Institute at Abbott Northwestern Hospital, MN (M.F., V.N.B., 
      S.G., M.W.D., G.H., H.S., M.G., M.E.-S., J.R.L., J.L.C., P.S.).
FAU - Gossl, Mario
AU  - Gossl M
AD  - Valve Science Center (V.N.B., S.G., M.W.D., H.S., M.G., M.E.-S., J.R.L., P.S.), 
      Minneapolis Heart Institute Foundation, MN.
AD  - Minneapolis Heart Institute at Abbott Northwestern Hospital, MN (M.F., V.N.B., 
      S.G., M.W.D., G.H., H.S., M.G., M.E.-S., J.R.L., J.L.C., P.S.).
FAU - Enriquez-Sarano, Maurice
AU  - Enriquez-Sarano M
AUID- ORCID: 0000-0003-0910-5450
AD  - Minneapolis Heart Institute at Abbott Northwestern Hospital, MN (M.F., V.N.B., 
      S.G., M.W.D., G.H., H.S., M.G., M.E.-S., J.R.L., J.L.C., P.S.).
FAU - Lesser, John R
AU  - Lesser JR
AD  - Valve Science Center (V.N.B., S.G., M.W.D., H.S., M.G., M.E.-S., J.R.L., P.S.), 
      Minneapolis Heart Institute Foundation, MN.
AD  - Minneapolis Heart Institute at Abbott Northwestern Hospital, MN (M.F., V.N.B., 
      S.G., M.W.D., G.H., H.S., M.G., M.E.-S., J.R.L., J.L.C., P.S.).
FAU - Cavalcante, Joao L
AU  - Cavalcante JL
AD  - Cardiovascular Imaging Research Center and Core Laboratory (M.F., G.H., J.L.C.), 
      Minneapolis Heart Institute Foundation, MN.
AD  - Minneapolis Heart Institute at Abbott Northwestern Hospital, MN (M.F., V.N.B., 
      S.G., M.W.D., G.H., H.S., M.G., M.E.-S., J.R.L., J.L.C., P.S.).
FAU - Sorajja, Paul
AU  - Sorajja P
AUID- ORCID: 0000-0001-6401-854X
AD  - Valve Science Center (V.N.B., S.G., M.W.D., H.S., M.G., M.E.-S., J.R.L., P.S.), 
      Minneapolis Heart Institute Foundation, MN.
AD  - Minneapolis Heart Institute at Abbott Northwestern Hospital, MN (M.F., V.N.B., 
      S.G., M.W.D., G.H., H.S., M.G., M.E.-S., J.R.L., J.L.C., P.S.).
LA  - eng
PT  - Journal Article
DEP - 20220708
PL  - United States
TA  - Circulation
JT  - Circulation
JID - 0147763
SB  - IM
MH  - Aortic Valve/diagnostic imaging/surgery
MH  - *Aortic Valve Stenosis/diagnostic imaging/etiology/surgery
MH  - *Heart Valve Prosthesis
MH  - Humans
MH  - Prosthesis Design
MH  - Risk Factors
MH  - *Transcatheter Aortic Valve Replacement/adverse effects
MH  - Treatment Outcome
OTO - NOTNLM
OT  - aortic stenosis
OT  - computed tomography
OT  - hypoattenuating leaflet thickening
OT  - transcatheter aortic valve replacement
EDAT- 2022/07/22 06:00
MHDA- 2022/08/11 06:00
CRDT- 2022/07/21 11:54
PHST- 2022/07/22 06:00 [pubmed]
PHST- 2022/08/11 06:00 [medline]
PHST- 2022/07/21 11:54 [entrez]
AID - 10.1161/CIRCULATIONAHA.121.058339 [doi]
PST - ppublish
SO  - Circulation. 2022 Aug 9;146(6):480-493. doi: 10.1161/CIRCULATIONAHA.121.058339. 
      Epub 2022 Jul 8.