Impact of underfilling and overfilling in balloon-expandable transcatheter aortic valve implantation assessed by multidetector computed tomography: Insights from the Optimized CathEter vAlvular iNtervention (OCEAN-TAVI) registry

Fumiaki Yashima; Masanori Yamamoto; Yusuke Watanabe; Kensuke Takagi; Yoshitake Yamada; Taku Inohara; Ryo Yanagisawa; Makoto Tanaka; Takahide Arai; Hideyuki Shimizu; Masahiro Jinzaki; Ken Kozuma; Keiichi Fukuda; Takahiko Suzuki; Kentaro Hayashida

doi:10.1016/j.ijcard.2016.07.218

Impact of underfilling and overfilling in balloon-expandable transcatheter aortic valve implantation assessed by multidetector computed tomography: Insights from the Optimized CathEter vAlvular iNtervention (OCEAN-TAVI) registry

Int J Cardiol. 2016 Nov 1:222:738-744. doi: 10.1016/j.ijcard.2016.07.218. Epub 2016 Jul 29.

Authors

Affiliations

¹ Department of Cardiology, Keio University School of Medicine, Tokyo, Japan.
² Department of Cardiology, Toyohashi Heart Center, Aichi, Japan.
³ Department of Cardiology, Teikyo University School of Medicine, Tokyo, Japan.
⁴ Department of Cardiology, New Tokyo Hospital, Chiba, Japan.
⁵ Department of Diagnostic Radiology, Keio University School of Medicine, Tokyo, Japan.
⁶ Department of Cardiovascular Surgery, Keio University School of Medicine, Tokyo, Japan.
⁷ Department of Cardiology, Keio University School of Medicine, Tokyo, Japan. Electronic address: k-hayashida@umin.ac.jp.

PMID: 27521550
DOI: 10.1016/j.ijcard.2016.07.218

Abstract

Background: Underfilling or overfilling of balloon-expandable transcatheter heart valves (THVs) during transcatheter aortic valve implantation (TAVI) is commonly used to improve conformity to small or calcified annuli in order to avoid serious complications. However, little is known about this technique. This study assessed the effects of underfilling and overfilling of THVs.

Methods and results: Data from 213 consecutive TAVI patients treated with balloon-expandable THVs in 4 Japanese centers between October 2013 and December 2014 were prospectively analyzed; 23-mm and 26-mm THVs were implanted in 96 cases (56 underfilling, 22 nominal filling, and 18 overfilling) and 38 cases (23 underfilling and 15 nominal filling), respectively. Pre/postprocedural multidetector computed tomography (MDCT) and echocardiographic data were compared. MDCT revealed that the minimum area of the underfilled 23-mm THVs was significantly decreased compared to that of nominal filled and overfilled THVs (308.3 SD 26.1 vs. 333.9 SD 14.7 vs. 347.8 SD 21.3mm(2), respectively, p<0.0001); analogous results were demonstrated for underfilled 26-mm THVs compared to nominal filled THVs (386.2 SD 34.6 vs. 423.6 SD 17.3mm(2), respectively, p=0.0004). The postprocedural transvalvular gradient of underfilled 23-mm THVs was significantly higher than that of nominal filled and overfilled THVs, while there were no differences for 26-mm THVs.

Conclusions: Underfilling or overfilling of THVs is safe and feasible, conforming to the original annulus and covering a continuous range of annular sizes with limited THV size options. However, care should be taken when underfilling 23-mm THVs due to the potential for increased transvalvular gradient.

Keywords: Aortic stenosis; Multidetector computed tomography; Overfilling; Transcatheter aortic valve implantation; Underfilling.

Publication types

Multicenter Study

MeSH terms

Aged, 80 and over
Aortic Valve / diagnostic imaging*
Aortic Valve / surgery
Aortic Valve Stenosis / diagnosis
Aortic Valve Stenosis / surgery*
Echocardiography, Transesophageal
Female
Follow-Up Studies
Heart Valve Prosthesis*
Humans
Imaging, Three-Dimensional*
Male
Multidetector Computed Tomography / methods*
Predictive Value of Tests
Prospective Studies
Prosthesis Design
Prosthesis Fitting / methods*
Registries
Severity of Illness Index
Transcatheter Aortic Valve Replacement / methods*
Treatment Outcome