Matheus Simonato1, John Webb1, Ran Kornowski1, Alec Vahanian1, Christian Frerker1, Henrik Nissen1, Sabine Bleiziffer1, Alison Duncan1, Josep Rodés-Cabau1, Guilherme F Attizzani1, Eric Horlick1, Azeem Latib1, Raffi Bekeredjian1, Marco Barbanti1, Thierry Lefevre1, Alfredo Cerillo1, José María Hernández1, Giuseppe Bruschi1, Konstantinos Spargias1, Alessandro Iadanza1, Stephen Brecker1, José Honório Palma1, Ariel Finkelstein1, Mohamed Abdel-Wahab1, Pedro Lemos1, Anna Sonia Petronio1, Didier Champagnac1, Jan-Malte Sinning1, Stefano Salizzoni1, Massimo Napodano1, Claudia Fiorina1, Antonio Marzocchi1, Martin Leon1, Danny Dvir1. 1. From the Centre for Heart Valve Innovation, Department of Cardiology, St. Paul's Hospital, Vancouver, Canada (M.S., J.W., D.D.); Division of Cardiovascular Surgery, Escola Paulista de Medicina-UNIFESP, São Paulo, Brazil (M.S., J.H.P.); Interventional Cardiology Institute, Cardiology Department, Rabin Medical Center, Petah Tivka, Israel (R.K.); Cardiology Department, Hôpital Bichat-Claude Bernard, Paris, France (A.V.); Department of Cardiology, Asklepios Klinik, Hamburg, Germany (C. Frerker); Department of Cardiology, Odense University Hospital, Denmark (H.N.); Department of Cardiovascular Surgery, Deutsches Herzzentrum München, Munich, Germany (S. Bleiziffer); Echocardiography Service, Royal Brompton and Harefield, London, United Kingdom (A.D.); Québec Heart and Lung Institute, Laval University, Québec City, Canada (J.R.-C.); Cardiovascular Imaging Core Laboratory, Case Western Research University, Cleveland, OH (G.F.A.); Peter Munk Cardiac Centre, University Health Network, University of Toronto, Canada (E.H.); Cardiologia Interventistica ed Emodinamica, Ospedale San Raffaele, Milan, Italy (A.L.); Kardiologie, Angiologie und Pneumologie, Zentrum für Innere Medizin, Universitätsklinikum Heidelberg, Germany (R.B.); Division of Cardiology, Ospedale Ferrarotto, Catania, Italy (M.B.); Institut Cardiovasculaire Paris Sud, Hôpital Jacques Cartier, Massy, France (T.L.); Fondazione Toscana Gabriele Monasterio, L'Ospedale del Cuore G. Pasquinucci, Massa, Italy (A.C.); Unidad de Hemodinámica y Cardiologia Intervencionista, Hospital Universitario Virgen de la Victoria, Malaga, Spain (J.M.H.); Dipartimento Cardiotoracovascolare, Ospedale Niguarda Ca' Granda, Milan, Italy (G.B.); Transcatheter Heart Valve Department, Hygeia Hospital, Athens, Greece (K.S.); UOC Emodinamica-Dipartimento Cardio Toracico, Azienda Ospedaliera Universitaria Senese, Siena, Italy (A.I.); Cardiac Catheterisation Laboratories, St. George's Hospital, London, United Kingdom (S. Brecker); Cardiac Ca
Abstract
BACKGROUND: Transcatheter valve implantation inside failed bioprosthetic surgical valves (valve-in-valve [ViV]) may offer an advantage over reoperation. Supra-annular transcatheter valve position may be advantageous in achieving better hemodynamics after ViV. Our objective was to define targets for implantation that would improve hemodynamics after ViV. METHODS AND RESULTS: Cases from the Valve-in-Valve International Data (VIVID) registry were analyzed using centralized core laboratory assessment blinded to clinical events. Multivariate analysis was performed to identify independent predictors of elevated postprocedural gradients (mean ≥20 mm Hg). Optimal implantation depths were defined by receiver operating characteristic curve. A total of 292 consecutive patients (age, 78.9±8.7 years; 60.3% male; 157 CoreValve Evolut and 135 Sapien XT) were evaluated. High implantation was associated with significantly lower rates of elevated gradients in comparison with low implantation (CoreValve Evolut, 15% versus 34.2%; P=0.03 and Sapien XT, 18.5% versus 43.5%; P=0.03, respectively). Optimal implantation depths were defined: CoreValve Evolut, 0 to 5 mm; Sapien XT, 0 to 2 mm (0-10% frame height); sensitivities, 91.3% and 88.5%, respectively. The strongest independent correlate for elevated gradients after ViV was device position (high: odds ratio, 0.22; confidence interval, 0.1-0.52; P=0.001), in addition to type of device used (CoreValve Evolut: odds ratio, 0.5; confidence interval, 0.28-0.88; P=0.02) and surgical valve mechanism of failure (stenosis/mixed baseline failure: odds ratio, 3.12; confidence interval, 1.51-6.45; P=0.002). CONCLUSIONS: High implantation inside failed bioprosthetic valves is a strong independent correlate of lower postprocedural gradients in both self- and balloon-expandable transcatheter valves. These clinical evaluations support specific implantation targets to optimize hemodynamics after ViV.
BACKGROUND: Transcatheter valve implantation inside failed bioprosthetic surgical valves (valve-in-valve [ViV]) may offer an advantage over reoperation. Supra-annular transcatheter valve position may be advantageous in achieving better hemodynamics after ViV. Our objective was to define targets for implantation that would improve hemodynamics after ViV. METHODS AND RESULTS: Cases from the Valve-in-Valve International Data (VIVID) registry were analyzed using centralized core laboratory assessment blinded to clinical events. Multivariate analysis was performed to identify independent predictors of elevated postprocedural gradients (mean ≥20 mm Hg). Optimal implantation depths were defined by receiver operating characteristic curve. A total of 292 consecutive patients (age, 78.9±8.7 years; 60.3% male; 157 CoreValve Evolut and 135 Sapien XT) were evaluated. High implantation was associated with significantly lower rates of elevated gradients in comparison with low implantation (CoreValve Evolut, 15% versus 34.2%; P=0.03 and Sapien XT, 18.5% versus 43.5%; P=0.03, respectively). Optimal implantation depths were defined: CoreValve Evolut, 0 to 5 mm; Sapien XT, 0 to 2 mm (0-10% frame height); sensitivities, 91.3% and 88.5%, respectively. The strongest independent correlate for elevated gradients after ViV was device position (high: odds ratio, 0.22; confidence interval, 0.1-0.52; P=0.001), in addition to type of device used (CoreValve Evolut: odds ratio, 0.5; confidence interval, 0.28-0.88; P=0.02) and surgical valve mechanism of failure (stenosis/mixed baseline failure: odds ratio, 3.12; confidence interval, 1.51-6.45; P=0.002). CONCLUSIONS: High implantation inside failed bioprosthetic valves is a strong independent correlate of lower postprocedural gradients in both self- and balloon-expandable transcatheter valves. These clinical evaluations support specific implantation targets to optimize hemodynamics after ViV.
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Authors: Pier Pasquale Leone; Fabio Fazzari; Francesco Cannata; Jorge Sanz-Sanchez; Antonio Mangieri; Lorenzo Monti; Ottavia Cozzi; Giulio Giuseppe Stefanini; Renato Bragato; Antonio Colombo; Bernhard Reimers; Damiano Regazzoli Journal: Front Cardiovasc Med Date: 2021-06-04