Mitral Valve Annular Morphology Shows Relevant Changes After Transcatheter Aortic Valve Implantation Procedures
Simon H. Sündermann, Alexander Meyer, Dustin Greve, Karel Van Praet, Axel Unbehaun, Volkmar Falk, Jörg Kempfert.
Deutsches Herzzentrum Berlin, Berlin, Germany.
Background: Changes in mitral valve annular morphology are described after conventional surgical aortic valve replacement. Aim of this study was to identify relevant changes in the mitral valve morphology after transcatheter aortic valve implantation (TAVI) in 3D-Echocardiography.
Methods: Eighty-five patients underwent a TAVI procedure. Sixty-seven patients had a transfemoral access, sixteen had a transapical access, one patient was implanted via a transaxillary access and one patient had a transaortic access. 44 patients had implantation of a balloon expandable valve. 3D-Volumetric TEE assessment of the mitral valve before and immediately after a TAVI procedure was performed in all patients. 4-6 cardiac cycles high-resolution images were generated, to reconstruct and measure the MV annulus. A dedicated software was used for assisted semi-automatic measurement of a variety of parameters of the mitral valve annulus.
Results: During systole, anterior-posterior (ap) diameter was reduced significantly after the procedure (3.77 ± 0.47 cm vs. 3.65 ± 0.45 cm; p<0.05). Sphericity index was reduced (0.91 ± 0.07 vs. 0.88 ± 0.08; p<0,05) as well as the tenting area (2.32 ± 0.85 cm2 vs. 1.97 ± 0.81 cm2; p< 0.007). Area of the mitral annulus was smaller after TAVI (10.47 ± 2.71 cm2 vs. 9.63 ± 2.50 cm2; p<0.05).. The angel between aortic and mitral annulus was less steep after the procedures (128.91 ± 14.11° vs. 137.27 ± 14.46° p < 0.001). These findings were similar during diastole. A larger reduction in ap-diameter could be found for patients that had an implantation of a balloon expandable valve compared to those implanted with a self expandable valve (-0.25 cm vs. -0.11cm, p<0.05), but only in systole. The reduction of the annular area was higher in the balloon expandable group (-1.2 ± 1.59 vs. -0.22 ± 1.41; p < 0.05). A similar reduction was found during diastole.
Conclusion: Mitral valve annulus anatomy shows relevant changes after TAVI procedures. The clinical relevance of these findings has to be investigated in a larger patient cohort. The choice of protheses (balloon- vs. selfexpandable) impacts changes in mitral annular geometry. These findings might be relevant for planning of procedures.
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