G. La Canna

Determinants of the degree of functional aortic regurgitation in patients with anatomically normal aortic valve and ascending thoracic aorta aneurysm. Transoesophageal Doppler echocardiography study

Objectives: To identify functional aortic regurgitation (FAR) determinants in patients with ascending thoracic aortic aneurysm (ATAA) and surgically confirmed normal aortic valve anatomy. Design: Case–control study. Setting: Non-invasive Cardiology and Cardiac Surgery Department. Patients: Eighty-nine patients with ATAA and varying degrees of FAR undergoing surgery, 40 age-matched patients with ATAA without aortic regurgitation and 20 normal control subjects. Interventions: Doppler and two-dimensional transoesophageal echocardiography. Main outcome measures: Vena contracta (VC) of aortic regurgitant jet, diastolic tented area and coaptation height (CH) of aortic valve leaflets, aortic dimension indexes—Valsalva sinus, sinotubular junction (STJ), tubular tract, annulus (A), STJ/A ratio. Results: When VC was used, a wide range of FAR was seen (mean (SD) 5.59 (2.59) mm, ranging from 2 to 13 mm). Of the variables tested, the most strongly associated with FAR severity in multivariate analysis was diastolic leaflet tenting, measured as CH (R2 = 0.69) (sensitivity 98%, specificity 95% using a cut-off value of CH ⩾1.1 cm). In turn, the diastolic leaflet tenting was strongly identified by the STJ/A ratio (sensitivity 87%, specificity 71% using a cut-off value of STJ/A >1.66). Conclusion: The diastolic tenting of aortic leaflets is strongly related to FAR severity in patients with ATAA. The mismatch of STJ/A is significantly associated with diastolic leaflet tenting and its correlated valve regurgitation, independently of the actual ATAA dimension. These findings provide new insight into the mechanism of FAR arising from ATAA.

Percutaneous mitral repair with the MitraClip.

Mitral regurgitation (MR) is associated with poor prognosis and high incidence of clinical events if left untreated. To reduce the invasiveness of the surgical approach, different types of trans-catheter procedures are becoming available. The MitraClip procedure (Abbott Vascular Inc. Menlo Park, CA) is yet the only available at the moment. The procedure is used to treat high risk surgical candidates with either functional or degenerative MR. Recent trials have shown that the procedure is safer than surgery, although less effective. Efficacy of the procedure depends on several factors, including patient selection, anatomy of the valve and the experience of the operators. However, when treating high risk patients a suboptimal repair obtained with low risk can be a acceptable outcome. In the future, novel devices, improved knowledge, more efficient imaging and transcatheter mitral prosthetic valve implantation may expand the indications to those patients currently not treated by MitraClip for anatomical unsuitability, as well as may improve the results both in term of early efficacy and long term durability.

040 Outcomes following transcatheter aortic valve implantation comparing Edwards SAPIEN with Medtronic CoreValve ReValving system devices: results from the Milan registry

Background To assess clinical outcomes of transcatheter aortic valve implantation comparing Medtronic CoreValve ReValving System® with Edwards SAPIEN XT. Methods All consecutive patients in our center with aortic stenosis treated with transfemoral Medtronic CoreValve ReValving System® (MCV) from November 2009 to September 2011 (learning curve patients excluded) or Edwards SAPIEN XT (ESV) from April 2010 to September 2011 when the device became available were included. Results In total, there were 192 patients in this analysis. The overall mean age was 79.4±8.1 years, logistic EuroSCORE 21.1±15.9% and STS-PROM score 8.8±8.6%. The MCV group consisted of a greater proportion of males (60.3% vs 43.7%; p=0.026) with a corresponding larger aortic annulus size (24.7±2.0 vs 23.4±1.7; p<0.001). The median clinical follow-up length was 171 (IQR 54–357) days. 30-day all cause mortality was 4.0%, myocardial infarction rate 1.0% and stroke 0.5%, with no differences between valve types. Life-threatening bleeding occurred in 14.7% and 11.5% had a major vascular complication. There were no differences in the combined safety endpoint at 30 days (ESV 72.2% vs MCV 71.9%; p=0.936). However, there was a significantly higher rate of device success among the ESV group (98.3% vs 90.4%; p=0.012) with additionally a significantly higher rate of conduction disturbances/arrhythmia (31.5% vs 16.0%; p=0.011) as well as pacemaker implantation (28.8% vs 5.0%; p<0.001) with MCV compared with ESV. Conclusions In our single center experience, transcatheter aortic valve implantation was a relatively safe and effective procedure utilising both commercially available devices. However, there was an increased incidence of arrhythmia and pacemaker implantation in the MCV group.