Christina Brinkmann1, Mohamed Abdel-Wahab2, Francesco Bedogni3, Oliver D Bhadra4, Gaetan Charbonnier5, Lenard Conradi4, David Hildick-Smith6, Faraj Kargoli7, Azeem Latib7, Nicolas M Van Mieghem8, Mizuki Miura9, Darren Mylotte10, Uri Landes11, Thomas Pilgrim12, Friedrich-Christian Riess13, Maurizio Taramasso9, Didier Tchétché5, Luca Testa3, Holger Thiele2, John Webb11, Stephan Windecker12, Julian Witt13, Peter Wohlmuth14, Alexander Wolf15, Joachim Schofer1. 1. MVZ Department Structural Heart Disease, Asklepios St. Georg, Hamburg, Germany. 2. Heart Center Leipzig, University of Leipzig, Leipzig, Germany. 3. Cardiologica, IRCCS Policlinico San Donato, Milan, Italy. 4. Universitäres Herz- und Gefäßzentrum Hamburg, Hamburg, Germany. 5. Service Cardiologie, Clinique Pasteur, Toulouse, France. 6. Sussex Cardiac Centre, Brighton & Sussex University Hospitals, Brighton, UK. 7. Division of Cardiology, Montefiore Medical Center / Albert Einstein College of Medicine, New York, USA. 8. Department Cardiology, Erasmus MC, Rotterdam, Netherlands. 9. Universitäres Herzzentrum, Universitätsspital Zürich, Zürich, Switzerland. 10. Cardiology Department, Bon Secours Hospital, Galway, Ireland. 11. Heart Centre, St. Paul's Hospital, Vancouver, British Columbia, Canada. 12. Inselspital Bern, Bern University Hospital, Bern, Switzerland. 13. Cardiothoracic Surgery, Albertinen Heart Center, Hamburg, Germany. 14. Asklepios ProResearch, Hamburg, Germany. 15. Klinik für Kardiologie, Elisabeth-Krankenhaus Essen, Essen, Germany.
Abstract
OBJECTIVES: To evaluate outcome and its predictors of bioprosthetic valve fracture (BVF) in patients undergoing valve-in-valve transcatheter aortic valve replacement (VIV-TAVR). BACKGROUND: BVF is feasible and reduces transvalvular gradients in VIV-TAVR-procedures, but follow-up-data and information on factors influencing the outcome are missing. METHODS: The 81 cases of BVF-VIV-TAVR were collected from 14 international centers. RESULTS: Predominantly transcatheter heart valve (THV) was implanted first, followed by BVF. VARC-2 defined device success was 93%, most failures were attributed to residual high gradients. Mean gradients decreased from 37 ± 13 mmHg to 10.8 ± 5.9 mmHg (p < 0.001). BVF reduced the gradient by 16 mmHg. During follow-up (FU, 281 ± 164 days) mean gradient remained stable (10.8 ± 5.9 mmHg at discharge, 12.4 ± 6.3 mmHg at FU, p = ns). In-hospital major adverse events occurred in 3.7%. Event-free survival at 276 ± 237.6 days was 95.4%. The linear mixed model identified balloon-expandable valves (BEV), Mitroflow surgical valve, stenotic surgical bioprostheses and balloon only 1 mm larger than the true internal diameter of the surgical valve as predictors for higher gradients. CONCLUSIONS: BVF is safe and can significantly reduce gradients, which remain stable at FU. BEV, Mitroflow surgical valve, stenotic bioprostheses and balloon larger than the true internal diameter of the surgical valve of only 1 mm are predictors for higher final gradients.
OBJECTIVES: To evaluate outcome and its predictors of bioprosthetic valve fracture (BVF) in patients undergoing valve-in-valve transcatheter aortic valve replacement (VIV-TAVR). BACKGROUND: BVF is feasible and reduces transvalvular gradients in VIV-TAVR-procedures, but follow-up-data and information on factors influencing the outcome are missing. METHODS: The 81 cases of BVF-VIV-TAVR were collected from 14 international centers. RESULTS: Predominantly transcatheter heart valve (THV) was implanted first, followed by BVF. VARC-2 defined device success was 93%, most failures were attributed to residual high gradients. Mean gradients decreased from 37 ± 13 mmHg to 10.8 ± 5.9 mmHg (p < 0.001). BVF reduced the gradient by 16 mmHg. During follow-up (FU, 281 ± 164 days) mean gradient remained stable (10.8 ± 5.9 mmHg at discharge, 12.4 ± 6.3 mmHg at FU, p = ns). In-hospital major adverse events occurred in 3.7%. Event-free survival at 276 ± 237.6 days was 95.4%. The linear mixed model identified balloon-expandable valves (BEV), Mitroflow surgical valve, stenotic surgical bioprostheses and balloon only 1 mm larger than the true internal diameter of the surgical valve as predictors for higher gradients. CONCLUSIONS: BVF is safe and can significantly reduce gradients, which remain stable at FU. BEV, Mitroflow surgical valve, stenotic bioprostheses and balloon larger than the true internal diameter of the surgical valve of only 1 mm are predictors for higher final gradients.
Authors: Hendrik Ruge; Hector A Alvarez-Covarrubias; Oliver Deutsch; Zahra Alalawi; Keti Vitanova; Rüdiger Lange Journal: Front Cardiovasc Med Date: 2022-06-02