Association between HALT incidence and deformation of transcatheter aortic valve prostheses: Sapien vs. Evolut vs. Navitor
K Onishi, M Yasuda, N Soejima, A Yoshida, K Fujita, H Matsuzoe, T Miyoshi, M Ueno, G NakazawaAbstract
Background
Hypoattenuating leaflet thickening (HALT) has been associated with the eccentricity of implanted transcatheter aortic valve (TAV). However, its relationship with valve type (balloon-expandable vs. self-expandable) or valve design (supra-annular vs. intra-annular) remains unclear. The purpose of our study was to investigate the incidence of HALT and valve eccentricity among TAV series (Sapien, Evolut, and Navitor).
Methods
We retrospectively evaluated 125 consecutive patients (Sapien: n = 54, Evolut: n = 39, Navitor: n = 32) who underwent transcatheter aortic valve replacement from December 2022 to April 2024. HALT and eccentricity of the implanted TAV were analyzed with 30-day postprocedural computed tomography. HALT was defined as involvement of more than 25% from the leaflet base in at least one leaflet, based on the Valve Academic Research Consortium 3 criteria.
Results
The overall incidence of HALT was 30.4%, with a significantly higher incidence in Navitor than in Sapien or Evolut (56.2% vs. 22.2% vs. 20.5%, p = 0.001). In all three groups (Sapien, Evolut, and Navitor), eccentricity at the leaflet inflow level was significantly greater in patients with HALT compared to without HALT (median 0.38 [IQR 0.36-0.45] vs. 0.34 [0.29-0.39]; p = 0.040, 0.59 [0.39-0.67] vs 0.36 [0.32-0.41]; p < 0.001, 0.64 [0.57-0.77] vs 0.44 [0.40-0.51]; p < 0.001). Eccentricity at the native annulus level was significantly lower in Sapien compared with Evolut and Navitor (0.36 [0.33-0.42] vs. 0.60 [0.48-0.67] and 0.59 [0.49-0.70], respectively; p < 0.001). Eccentricity at the leaflet inflow level was significantly greater in Navitor compared with Sapien and Evolut (0.36 [0.31-0.39] and 0.36 [0.33-0.44] vs. 0.57 [0.45-0.67], respectively; p < 0.001).
Conclusion
The self-expandable, intra-annular design is more affected by the device landing zone and results in leaflet level deformation, leading to increased incidence of HALT.For image description, please refer to the figure legend and surrounding text.