Procedural characteristics and prosthesis sizing.
The procedure was successful in 97.1% (130/134) and device success was 96.3% (129/134). Four patients were converted to open-heart procedures during the operation (one coronary obstruction, two valvular embolisms, and one valve migration) (Table 2). We updated our protocol in subsequent cases to prevent this complication, including a mandatory repeat of root angiography from confirming the clasper’s position and configuration after deployment. There was no valve dislodgements after that update. In one patient that mismatch led to moderate PVL and cardiac insufficiency six days after the operation.
The mean aortic annular diameter was 24.9±2.7 mm, resulting in a median prosthesis oversizing by area of 6.4%. The 21-mm, 23-mm, 25-mm, 27-mm, and the 29-mm prosthesis valves were implanted in 2.2%, 10.4%, 23.1%, 41.0%, and 23.1%, respectively in the enrolled patients. Deformation dynamics of the aortic valve annulus in different valve pathologies may vary in different forms of AS. Caution should be used during annular sizing in patients undergoing TAVR. The new permanent pacemaker implantation (PPMI) rate was 7.4%. Myocardial infarction, cerebrovascular events, coronary obstruction requiring intervention, life-threatening bleeding and endocarditis were not observed. The median time of stay in the intensive care unit was one (1-1) day. The average postoperative hospital stay was six (5-8) days.
Echocardiographic outcomes and Functional status.
Echocardiographic assessments of the heart function at baseline and follow-up are shown in Table 3. The mean gradient pressure remained stable at one month, six months and twelve months (8.2±3.2 mmHg, 9.6±5.3 mmHg and 10.2±4.1 mmHg, respectively). The aortic valve peak velocity was 1.9±0.3 m/s at one month, 2.1±0.4 m/s at six months and 2.2±0.5 m/s at one year. Interestingly, 79.8% had no or only traced PVL, 18.5% had mild PVL, while two patients had moderate or severe PVL at twelve months.
Significant changes were observed in echocardiographic parameters such as: left ventricular end diastolic dimension (LVEDD), left ventricular end systolic dimension (LVESD), and left ventricular end-diastolic volume (LVEDV). However left ventricle ejection fraction (LVEF) increased significantly after twelve months compared to baseline. The LVEF was 52.1±12.8% at baseline and it increased to 57.3±11.4% at the twelve months follow-up (Figure 5).