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TAVR preserved more mitral geometry than surgical approach
Research that applied real-time 3-D echocardiography concluded that transcatheter aortic valve replacement may be a more physiologic approach to aortic replacement than surgical aortic valve replacement because it better preserves mitral annular geometry.
To compare the immediate effect of TAVR and standard surgical AVR on mitral annular anatomy, researchers performed the 3-D echocardiography in 10 patients using the Sapien valve (Edwards Lifesciences) or 10 patients undergoing surgical AVR for severe aortic stenosis.
Mitral annular geometric indexes were measured to assess regional and global annular geometry.
In the TAVR cohort, 50% of patients had mild mitral regurgitation, 40% had moderate mitral regurgitation and 10% had severe mitral regurgitation. In the surgical AVR cohort, 20% of patients had no mitral regurgitation, 40% had mild mitral regurgitation and 40% had moderate mitral regurgitation. Postoperatively, mitral regurgitation remained unchanged for 50% of TAVR patients and improved in 50%, whereas in the surgical AVR cohort, 60% had unchanged mitral regurgitation and 40% had an improvement in mitral regurgitation.
There were no preoperative differences in any of the mitral annular geometric indices between the two groups. However, postoperative analysis found that patients who underwent surgical AVR had significant decrease in annular height, septolateral diameter, mitral valve transverse diameter and mitral annular area after valve replacement (P<.006). These changes were not seen in the TAVR group.
“There is a higher degree of improvement in [mitral regurgitation] when patients have less preoperative [mitral regurgitation],” the researchers wrote. “As such, it could be hypothesized that TAVR might provide a more durable option for improving [functional mitral regurgitation] in the setting of aortic stenosis, as it preserves the natural annular saddle shape and geometric dimensions to a greater degree than AVR.”
Disclosure: The researchers report no relevant financial disclosures.