Andreas Holzamer1, Won-Keun Kim2, Andreas Rück3, Janarthanan Sathananthan4, Lukas Keller5, Joseph Cosma6, Timm Bauer7, Holger Nef7, Ignacio J Amat-Santos8, Miriam Brinkert9, Oliver Husser10, Costanza Pellegrini10, Joachim Schofer11, Roberto Nerla12, Matteo Montorfano13, Francesco Giannini13, Pieter Stella14, Shingo Kuwata5, Michael Hilker1, Fausto Castriota12, Gian Paolo Ussia6, John G Webb4, Fabian Nietlispach5, Stefan Toggweiler15. 1. Department of Cardiothoracic Surgery, University of Regensburg Medical Center, Regensburg, Germany. 2. Department of Cardiology and Cardiac Surgery, Kerckhoff Heart and Lung Center, Bad Nauheim, Germany. 3. Department of Medicine, Unit of Cardiology, Karolinska University Hospital, Stockholm, Sweden. 4. Centre for Heart Valve Innovation, St. Paul's and Vancouver General Hospitals, University of British Columbia, Vancouver, Canada. 5. Department of Cardiology, University Hospital Zürich, Zurich, Switzerland. 6. Department of Cardiology, University Campus Bio/Medico, University of Rome Tor Vergata, Rome, Italy. 7. Department of Cardiology, University Hospital Giessen, Giessen, Germany. 8. Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares, Department of Cardiology, Hospital Universitario de Valladolid, Valladolid, Spain. 9. Division of Cardiology, Heart Center Lucerne, Luzerner Kantonsspital, Lucerne, Switzerland. 10. Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Munich, Germany. 11. Albertinen Herzzentrum und Medizinisches Versorgungszentrum Prof. Dr. Mathey, Hamburg, Germany. 12. Cardiovascular Department, Humanitas Gavazzeni, Bergmo, Italy. 13. Interventional Cardiology Unit, San Raffaele Institute, Milan, Italy. 14. Department of Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands. 15. Division of Cardiology, Heart Center Lucerne, Luzerner Kantonsspital, Lucerne, Switzerland. Electronic address: stefan.toggweiler@luks.ch.
Abstract
OBJECTIVES: This study reports an international experience using the transfemoral ACURATE neo transcatheter heart valve (Boston Scientific, Marlborough, Massachusetts) for the treatment of degenerated surgical aortic bioprostheses. BACKGROUND: Transcatheter valve-in-valve procedures have emerged as an alternative to redo surgery. Supra-annular prostheses might be particularly useful in this indication. METHODS: This is an international multicenter analysis including 85 patients from 14 centers in Europe and Canada undergoing an ACURATE neo valve-in-valve procedure from March 2015 to February 2019. RESULTS: Internal diameter of the degenerated bioprosthesis was 20.3 ± 2.1 mm. Prosthesis size S was used in 70 (82%) procedures. The median depth of implantation was 3 mm and the upper crown of the ACURATE neo was positioned above the stent posts of the degenerated bioprosthesis in 54 (64%) and inside in 31 (36%). Mean transvalvular gradient before discharge was significantly lower if the upper crown was above the degenerated bioprosthesis (13.7 ± 5.9 mm Hg vs. 19.5 ± 10.0 mm Hg; p = 0.001). However, a high position of the ACURATE neo resulted in embolization in 1 patient, conversion to open-heart surgery in 1, and need for reintervention due to transcatheter heart valve failure within the first 18 months of follow-up in 4. CONCLUSIONS: This early experience shows that a high implantation of the ACURATE neo with the upper crown above the stent posts of the degenerated bioprosthesis resulted in lower mean transvalvular gradients but a higher rate of malpositioning and early valve degeneration.
OBJECTIVES: This study reports an international experience using the transfemoral ACURATE neo transcatheter heart valve (Boston Scientific, Marlborough, Massachusetts) for the treatment of degenerated surgical aortic bioprostheses. BACKGROUND: Transcatheter valve-in-valve procedures have emerged as an alternative to redo surgery. Supra-annular prostheses might be particularly useful in this indication. METHODS: This is an international multicenter analysis including 85 patients from 14 centers in Europe and Canada undergoing an ACURATE neo valve-in-valve procedure from March 2015 to February 2019. RESULTS: Internal diameter of the degenerated bioprosthesis was 20.3 ± 2.1 mm. Prosthesis size S was used in 70 (82%) procedures. The median depth of implantation was 3 mm and the upper crown of the ACURATE neo was positioned above the stent posts of the degenerated bioprosthesis in 54 (64%) and inside in 31 (36%). Mean transvalvular gradient before discharge was significantly lower if the upper crown was above the degenerated bioprosthesis (13.7 ± 5.9 mm Hg vs. 19.5 ± 10.0 mm Hg; p = 0.001). However, a high position of the ACURATE neo resulted in embolization in 1 patient, conversion to open-heart surgery in 1, and need for reintervention due to transcatheter heart valve failure within the first 18 months of follow-up in 4. CONCLUSIONS: This early experience shows that a high implantation of the ACURATE neo with the upper crown above the stent posts of the degenerated bioprosthesis resulted in lower mean transvalvular gradients but a higher rate of malpositioning and early valve degeneration.