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American Heart Association

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Final ID: MDP1491

Differences on Periprocedural Blood Flow Dynamics between Self- and Balloon-expandable Valves in Patients with Small Aortic Annulus Undergoing Transcatheter Aortic Replacement

Abstract Body (Do not enter title and authors here): Backgrounds: A recent trial has shown that the supra-annular self-expanding valve (SEV) is superior for valve function and noninferior for clinical outcomes at one year compared to the balloon-expandable valve (BEV) in patients with aortic stenosis (AS) and small aortic annulus (SAA) undergoing transcatheter aortic valve replacement (TAVR). However, differences on blood flow hemodynamics between the valves remain unclear. We aimed to investigate these differences between the SEV and BEV using four-dimensional flow cardiovascular magnetic resonance imaging (4D flow CMR).
Methods: We prospectively examined 95 consecutive patients with severe AS and a SAA who underwent TAVR between May 2018 and April 2024 (31 SEV and 64 BEV). SAA was defined as ≤430 mm2 based on the trial. We compared the changes in blood flow patterns, wall shear stress (WSS), and energy loss (EL) in the ascending aorta (AAo) between the SEV and BEV using 4D flow CMR.
Results: The absolute reductions in the vortical flow, helical flow and flow eccentricity were significantly higher in the SEV group than in the BEV group after TAVR (SEV: -0.35 ± 0.88 vs. BEV: 0.15 ± 1.01, P = 0.02, SEV: -0.87 ± 0.81 vs. BEV: -0.38 ± 0.88, P = 0.003, and SEV: -0.61 ± 0.92 vs. BEV: -0.21 ± 0.83, P = 0.037, respectively) (Figure 1A-C). The absolute reduction of average WSS was significantly higher in the SEV group than that in the BEV group after TAVR (SEV: -1.9 [-3.7 – -0.90] Pa vs. BEV: -0.94 [-2.6 – 0.35] Pa, P = 0.049) (Figure 1D). The systolic EL significantly decreased after TAVR in both groups, whereas its absolute reduction was comparable between the groups (SEV: -4.9 [-7.6 – 0.21] mW vs. BEV: -4.4 [-9.5 – 1.5] mW, P = 0.61).
Conclusions: The vortical flow, helical flow, flow eccentricity, and average WSS in the AAo after TAVR were significantly decreased in the SEV compared to those in the BEV in patients with SAA undergoing TAVR. Our findings suggest the favorable profile on blood flow dynamics in the supra-annular SEV, possibly supporting its superiority of valve function.
  • Hamaya, Takeshi  ( Hokkaido University Hospital , Sapporo , Japan )
  • Takenaka, Sakae  ( Hokkaido University Hospital , Sapporo , Japan )
  • Ishizaka, Suguru  ( Hokkaido University Hospital , Sapporo , Japan )
  • Sato, Takuma  ( Hokkaido University Hospital , Sapporo , Japan )
  • Konishi, Takao  ( Hokkaido University Hospital , Sapporo , Japan )
  • Anzai, Toshihisa  ( Hokkaido University Hospital , Sapporo , Japan )
  • Nagai, Toshiyuki  ( Hokkaido University Hospital , Sapporo , Japan )
  • Kamiya, Kiwamu  ( Hokkaido University Hospital , Sapporo , Japan )
  • Tsuneta, Satonori  ( Hokkaido University Hospital , Sapporo , Japan )
  • Komoriyama, Hirokazu  ( Kushiro City General Hospital , Kushiro , Japan )
  • Takahashi, Yuki  ( Hakodate National Hospital , Hakodate , Japan )
  • Takahashi, Akinori  ( Hokkaido University Hospital , Sapporo , Japan )
  • Mori, Yuki  ( Hokkaido University Hospital , Sapporo , Japan )
  • Naito, Seiichiro  ( Hokkaido University Hospital , Sapporo , Japan )
  • Author Disclosures:
    Takeshi Hamaya: DO NOT have relevant financial relationships | Sakae Takenaka: DO NOT have relevant financial relationships | Suguru Ishizaka: No Answer | Takuma Sato: DO NOT have relevant financial relationships | Takao Konishi: DO NOT have relevant financial relationships | Toshihisa Anzai: DO NOT have relevant financial relationships | Toshiyuki Nagai: DO have relevant financial relationships ; Speaker:Bayer Yakuhin, Ltd:Past (completed) ; Research Funding (PI or named investigator):Mitsubishi Tanabe Pharma:Past (completed) ; Speaker:Viatris Japan, Inc:Past (completed) ; Speaker:Boehringer Ingelheim Japan, Inc:Past (completed) ; Speaker:Kyowa Kirin Co., Ltd:Past (completed) | Kiwamu Kamiya: DO NOT have relevant financial relationships | Satonori Tsuneta: DO NOT have relevant financial relationships | Hirokazu Komoriyama: DO NOT have relevant financial relationships | Yuki Takahashi: No Answer | Akinori Takahashi: DO NOT have relevant financial relationships | Yuki Mori: DO NOT have relevant financial relationships | Seiichiro Naito: No Answer
Meeting Info:

Scientific Sessions 2024

2024

Chicago, Illinois

Session Info:

Advances in Native and Replaced Valves Care Research

Monday, 11/18/2024 , 11:10AM - 12:35PM

Moderated Digital Poster Session

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