Upsizing of Epic Supra Aortic Bioprosthesis Improves Mean Transaortic Pressure Gradients – A Long-term Follow up

T. Caldonazo¹, H. Kirov², A. Moschovas², M. Mukharyamov², I. saqer², D. Haji², Y. Rohoza², G. Jr. Jr Soletti³, G. Faerber⁴, T. Doenst^4
1Jena University Hopsital, Jena, Thuringen ²Jena University Hospital, Jena, Thuringen ³Weill Cornell Medicine, New York, New York ⁴University Hospital Jena, Department of Cardiothoracic Surgery, Jena, Thuringen

Purpose: Current sizing-strategies in aortic valve replacement suggest valve selection based on the annulus diameter. However, it is possible to size intra-annularly followed by replica-sizing. In many patients, the native aortic root allows the supraannular placement of a bioprosthesis one/two sizes larger than that indicated by the aortic annulus diameter (“upsizing”).

Methods: We analyzed data of all patients (n=1,796) who underwent aortic valve replacement (AVR) with the EpicSupra bioprosthesis between 01/2010 to 12/2021 in our center. The primary endpoint of this study was mean transaortic pressure gradients (MPG) at latest follow-up, secondary endpoint was long-term survival. A matching method using regression-adjusted inverse probability weights (IPWRA) was conducted.

Results: Patients with unknown annulus dimensions or with aortic annulus size 29 (no upsizing possible) were excluded from the analysis. The remaining 1,422 patients were divided in 2 groups according to the sizing strategy used at implantation: upsizing (UG, n=1,034) and standard-sizing (SG, N=388) group. Two pairs of 327 patients were analyzed after IPWRA. After adjustment, the MPG were lower in the UG (11.6±6.3 mmHg – UG and 13.4±.5.9 mmHg – SG, p=0.002 – Fig. 1A), and the long-term survival was similar between the groups (HR: 1.28, 95% CI, 0.47-3.46, p=0.63 - Fig. 1B). Upsizing did not impair perioperative outcomes.

Conclusion: Using an AVR upsizing strategy is associated with lower MPG at long-term follow up compared to standard-sizing. The reductions in pressure gradients did not show an association with better 10-year survival after matching.

Identify the source of the funding for this research project: Deutsche Forschungsgemeinschaft (DFG, German Research Foundation)