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FOCUS ISSUE: VALVULAR HEART DISEASE: CLINICAL RESEARCH

Comparison of the Hemodynamic Performance of Percutaneous and Surgical Bioprostheses for the Treatment of Severe Aortic Stenosis

Marie-Annick Clavel, DVM, MSc^_*, John G. Webb, MD, Philippe Pibarot, DVM, PhD^_*, Lukas Altwegg, MD, Eric Dumont, MD^_*, Chris Thompson, MD, Robert De Larochellière, MD^_*, Daniel Doyle, MD^_*, Jean-Bernard Masson, MD, Sebastien Bergeron, MD^_*, Olivier F. Bertrand, MD, PhD^_* and Josep Rodés-Cabau, MD^_*,_*

^_* Quebec Heart & Lung Institute/Laval Hospital, Laval University, Québec City, Québec, Canada
St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada

Manuscript received October 15, 2008; revised manuscript received January 6, 2009, accepted January 25, 2009.

^_* Reprint requests and correspondence: Dr. Josep Rodés-Cabau, Quebec Heart & Lung Institute/Laval Hospital, 2725 Chemin Ste-Foy, Québec City, Quebec G1V 4G5, Canada (Email: josep.rodes{at}criucpq.ulaval.ca).

Objectives: This study was undertaken to compare the hemodynamic performance of a percutaneous bioprosthesis to that of surgically implanted (stented and stentless) bioprostheses for the treatment of severe aortic stenosis.

Methods: Fifty patients who underwent percutaneous aortic valve implantation (PAVI) with the Cribier-Edwards or Edwards SAPIEN bioprosthetic valve (Edwards Lifesciences, Inc., Irvine, California) were matched 1:1 for sex, aortic annulus diameter, left ventricular ejection fraction, body surface area, and body mass index, with 2 groups of 50 patients who underwent surgical aortic valve replacement (SAVR) with a stented valve (Edwards Perimount Magna [SAVR-ST group]), or a stentless valve (Medtronic Freestyle, Medtronic, Minneapolis, Minnesota [SAVR-SL group]). Doppler echocardiographic data were prospectively obtained before the intervention, at discharge, and at 6- to 12-month follow-up.

Results: Mean transprosthetic gradient at discharge was lower (p < 0.001) in the PAVI group (10 ± 4 mm Hg) compared with the SAVR-ST (13 ± 5 mm Hg) and SAVR-SL (14 ± 6 mm Hg) groups. Aortic regurgitation (AR) occurred more frequently in the PAVI group (mild: 42%, moderate: 8%) compared with the SAVR-ST (mild: 10%, moderate: 0%) and SAVR-SL (mild: 12%, moderate: 0%) groups (p < 0.0001). At follow-up, the mean gradient in the PAVI group remained lower (p < 0.001) than that of the SAVR-ST group, but was similar to that of the SAVR-SL group. The incidence of severe prosthesis-patient mismatch was significantly lower (p = 0.007) in the PAVI group (6%) compared with the SAVR-ST (28%) and SAVR-SL (20%) groups. However, the incidence of AR remained higher (p < 0.0001) in the PAVI group compared with the 2 other groups.

Conclusions: PAVI provided superior hemodynamic performance compared with the surgical bioprostheses in terms of transprosthetic gradient and prevention of severe prosthesis-patient mismatch, but was associated with a higher incidence of AR.

Key Words: aortic stenosis • heart valve prosthesis • percutaneous aortic valve implantation • aortic valve replacement • bioprosthesis • hemodynamics

Abbreviations and Acronyms   AR = aortic regurgitation   EOA = effective orifice area   EOAi = indexed effective orifice area   LVEF = left ventricular ejection fraction   PAVI = percutaneous aortic valve implantation   PPM = prosthesis-patient mismatch   SAVR = surgical aortic valve replacement

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