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Rigshospitalet - en del af Københavns Universitetshospital
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Computed tomography-based oversizing and incidence of paravalvular aortic regurgitation and permanent pacemaker implantation with a new-generation self-expanding transcatheter heart valve

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DOI

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  • Ung Kim
  • Philipp Blanke
  • Stephan Windecker
  • Albert M Kasel
  • Ulrich Schäfer
  • Darren Walters
  • Axel Linke
  • Herve Le Breton
  • Gerhard Schymik
  • Mark S Spence
  • Lars Søndergaard
  • Mohammed Abdel-Wahab
  • Stephen Worthley
  • Didier Tchétché
  • Hermann Reichenspurner
  • Mickael Ohana
  • Stephanie L Sellers
  • Jonathon A Leipsic
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AIMS: We aimed to evaluate the relationship between CT-based annular perimeter oversizing and the incidence of paravalvular aortic regurgitation (PAR) and permanent pacemaker (PPM) implantation in patients treated with the new self-expanding CENTERA transcatheter heart valve (THV) for severe aortic stenosis.

METHODS AND RESULTS: One hundred and ninety-eight patients in the CENTERA-EU trial were stratified a priori into four groups based on the perimeter oversizing (2.5-10%, 10-15%, 15-20% and >20%). PAR at 30 days was moderate or higher in 0.6% of patients. The frequency of PPM implantation was 4.9%. The mean perimeter oversizing was 16.2±5.6%. For patients with a perimeter oversizing >10%, an inverse relationship between oversizing and ≥mild PAR was observed (43.3% for 10-15% oversizing; 37.7%, 15-20%; 33.3%, >20%). No association between oversizing and effective orifice area was observed. The optimal cut-off value of perimeter oversizing for the prediction of ≥mild PAR was 15.9% (AUC 0.718, 95% CI: 0.576, 0.860). No annular ruptures were observed.

CONCLUSIONS: The CENTERA THV appears to have a wide range of sizing tolerance. The degree of oversizing to mitigate PAR is relatively low compared to other self-expanding transcatheter devices. There appears to be no compromise between occurrence of PAR and PPM across this wide range of oversizing.

OriginalsprogEngelsk
TidsskriftEuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology
Vol/bind14
Udgave nummer5
Sider (fra-til)e511-e518
ISSN1774-024X
DOI
StatusUdgivet - 3 aug. 2018

ID: 56523453