In vitro Doppler versus catheter transvalvular pressure gradients in balloon‐expandable versus self‐expanding transcatheter aortic valves

• Published in: Catheterization and cardiovascular interventions Vol. 99; no. 1; pp. 201 - 210
• Main Authors: Stanová, Viktória, Rieu, Régis, Côté, Nancy, Salaun, Erwan, Rodés‐Cabau, Josep, Pibarot, Philippe
• Format: Journal Article
• Language: English
• Published: Hoboken, USA John Wiley & Sons, Inc 01.01.2022; Wiley Subscription Services, Inc; Wiley
• Subjects: Aortic valve; Aortic Valve - diagnostic imaging; Aortic Valve - surgery; aortic valve disease; Aortic Valve Stenosis - diagnostic imaging; Aortic Valve Stenosis - surgery; Balloon treatment; Catheterization; Catheters; diagnostic; Doppler echocardiography; Doppler effect; Echocardiography; Engineering Sciences; Heart rate; Heart Valve Prosthesis; Humans; Pressure; Prosthesis Design; Transcatheter Aortic Valve Replacement - adverse effects; transcatheter valve implantation; Treatment Outcome; Ventricle; catheterization; transcatheter valve implantation; Doppler echocardiography; diagnostic; aortic valve disease
• ISSN: 1522-1946; 1522-726X
• DOI: 10.1002/ccd.29974

Objectives The objective of this in vitro study was to compare Doppler versus catheter transvalvular pressure gradients (TPG) in third generations balloon‐expandable (BE) versus self‐expanding (SE) transcatheter heart valves (THV). Background TPG is a key parameter to assess and follow valve hemodynamic function following transcatheter aortic valve implantation (TAVI). It remains uncertain and debated whether, and to which extent, TPGs differ according to the type of THV, that is, BE versus SE and to the method used for TPG measurement, that is, Doppler echocardiography versus cardiac catheterization. Methods The CoreValve EVOLUT PRO 26 mm and the SAPIEN 3 23 mm THVs were tested in a left heart simulator using a 21 mm aortic annulus under following conditions: heart rate: 70 bpm, mean aortic pressure: 100 mmHg, stroke volume: 30, 70 and 100 ml. Mean TPGs were measured by continuous‐wave Doppler and by micro‐tip pressure catheters positioned in the left ventricle and at 50 mm downstream to the tip of the THV leaflets. Results Doppler TPGs (9.5 ± 3.9 mmHg) were on average 40.5 ± 13.9% higher (p < 0.001) than catheter TPGs (6.3 ± 3.4 mmHg). Both Doppler and catheter TPGs were lower (p = 0.003) in the SE versus BE THVs (Doppler: 8.7 ± 3.5 vs. 10.7 ± 4.6; catheter: 5.0 ± 1.7 mmHg vs. 7.1 ± 2.2). The Doppler versus catheter difference in TPG increased with the higher flow conditions. The Doppler versus catheter difference in TPG was similar in BE versus SE THVs (3.6 ± 1.1 vs. 3.7 ± 1.4 mmHg or 42 ± 9 vs. 47 ± 9%; p = 0.58) overall and in each flow conditions. Conclusion The Doppler TPGs are, on average, 40% higher than the catheter TPGs for both BE and SE THVs. The SE THV had lower Doppler and catheter TPGs compared to the BE THV, at normal and high flow states. The absolute and percent differences between Doppler versus catheter TPGs were similar in BE versus SE THVs.