Randomised comparison of a balloon-expandable and self-expandable valve with quantitative assessment of aortic regurgitation using magnetic resonance imaging

Abstract

Introduction Transcatheter aortic valve implantation (TAVI) is a safe and effective treatment for inoperable, intermediate-or high-risk patients with severe symptomatic aortic stenosis and has been associated with excellent clinical outcomes. A clinically relevant remaining problem is aortic regurgitation (AR) post-TAVI, which is associated with increased mortality. Therefore, we conducted a prospective randomised trial to assess the safety and efficacy of a first-generation self-expandable valve (SEV; CoreValve) and a third-generation balloon-expandable valve (BEV; Sapien 3) with respect to clinical outcomes and AR

Acute Aortic Regurgitation After Transcatheter Aortic Valve Implantation Procedure

“…AR is a significant complication of TAVI, which can hugely impact patients’ recovery and affect mortality in the long term. Moderate or severe AR after TAVI is associated with an increased risk of mortality [ 2 , 3 ]. Therefore, it is crucial to pay close attention to these risks and thoroughly assess patients, particularly those with low surgical risk.…”

“…The leakage can be in the form of total AR or paravalvular regurgitation [ 3 ]. AR is usually attributed to either failure of the prosthesis [ 4 , 5 ] or underexpansion of the valve, usually after implanting a large valve into a small annulus [ 4 , 6 ].…”

“…The choice of valve can also affect the development of leakage post-TAVI [ 3 ]. The most commonly used valve groups are self-expandable valves (SEV) and balloon-expandable valves (BEV).…”

Comments on: ‘Randomised comparison of a balloon-expandable and self-expandable valve with quantitative assessment of aortic regurgitation using magnetic resonance imaging’

“…We read with interest the paper by Kooistra et al. [ 1 ], who reported on the superiority of a balloon-expandable valve (BEV, SAPIEN 3) over a self-expandable valve (SEV, CoreValve) in terms of aortic regurgitation (AR) and clinical outcome up to 1 year after transcatheter aortic valve implantation (TAVI) in a randomised comparison with quantitative AR assessment using magnetic resonance imaging (MRI).…”

Reply to the letter of Soliman et al. regarding ‘Randomised comparison of a balloon-expandable and self-expandable valve with quantitative assessment of aortic regurgitation using magnetic resonance imaging’

“…However, we believe there has been a misunderstanding concerning the purpose of the ELECT study results. As mentioned in the Background section of our article [ 2 ], the use of quantitative phase-contrast magnetic resonance imaging (MRI) as a tool to accurately assess the severity of aortic valve regurgitation (AR) was tested in a clinical setting. Although quantitative aortography with videodensitometric assessment is indeed also a promising tool to accurately assess AR, an important limitation of this technique compared to MRI is that quantitative aortography is less suitable for (non-invasive) follow-up.…”