BACKGROUND: Bioprosthetic valve fracture (BVF) is a technique to reduce gradients in valve-in-valve transcatheter aortic valve implantation (VIV-TAVI) procedures. Outcome of VIV-TAVI with BVF has not been compared with VIV-TAVI without BVF. AIMS: To evaluate the outcome of VIV-TAVI with BVF compared to VIV-TAVI without BVF. METHODS: In total, 81 cases of BVF-VIV-TAVI (BVF-group) from 14 centres were compared to 79 cases of VIV-TAVI without BVF (control-group). RESULTS: VARC-2 defined device success was 93% in the BVF- and 68.4% in the control-group (p<0.001). The mean transvalvular gradient decreased from 37 ± 13mmHg to 10.8 ± 5.9mmHg (p<0.001) in the BVF- and from 35 ± 16mmHg to 15.8 ± 6.8mmHg (p<0.001) in the control-group with a significantly higher final gradient in control (p<0.001). The transvalvular gradients did not significantly change over time. In-hospital major adverse events occurred in 3.7% in BVF- and 7.6% in control-group (p=0.325). A linear mixed model identified BVF, self-expanding transcatheter heart valves (THVs) and other surgical aortic valve (SAV) types other than Mitroflow as predictors for lower transvalvular gradients. CONCLUSIONS: Compared to VIV-TAVI alone, VIV-TAVI with BVF resulted in a significantly lower transvalvular gradient acutely and at follow-up. Independent predictors for lower gradients were the use of self-expanding THVs and the treatment of SAVs other than Mitroflow, irrespective of BVF-performance. BVF significantly reduced the gradient independently from transcatheter or surgical valve type.
BACKGROUND: Bioprosthetic valve fracture (BVF) is a technique to reduce gradients in valve-in-valve transcatheter aortic valve implantation (VIV-TAVI) procedures. Outcome of VIV-TAVI with BVF has not been compared with VIV-TAVI without BVF. AIMS: To evaluate the outcome of VIV-TAVI with BVF compared to VIV-TAVI without BVF. METHODS: In total, 81 cases of BVF-VIV-TAVI (BVF-group) from 14 centres were compared to 79 cases of VIV-TAVI without BVF (control-group). RESULTS: VARC-2 defined device success was 93% in the BVF- and 68.4% in the control-group (p<0.001). The mean transvalvular gradient decreased from 37 ± 13mmHg to 10.8 ± 5.9mmHg (p<0.001) in the BVF- and from 35 ± 16mmHg to 15.8 ± 6.8mmHg (p<0.001) in the control-group with a significantly higher final gradient in control (p<0.001). The transvalvular gradients did not significantly change over time. In-hospital major adverse events occurred in 3.7% in BVF- and 7.6% in control-group (p=0.325). A linear mixed model identified BVF, self-expanding transcatheter heart valves (THVs) and other surgical aortic valve (SAV) types other than Mitroflow as predictors for lower transvalvular gradients. CONCLUSIONS: Compared to VIV-TAVI alone, VIV-TAVI with BVF resulted in a significantly lower transvalvular gradient acutely and at follow-up. Independent predictors for lower gradients were the use of self-expanding THVs and the treatment of SAVs other than Mitroflow, irrespective of BVF-performance. BVF significantly reduced the gradient independently from transcatheter or surgical valve type.
Authors: Luca Testa; Matteo Casenghi; Enrico Criscione; Nicolas M Van Mieghem; Didier Tchétché; Anita W Asgar; Ole De Backer; Azeem Latib; Bernhard Reimers; Giulio Stefanini; Carlo Trani; Francesco Giannini; Antonio Bartorelli; Wojtek Wojakowski; Maciej Dabrowski; Dariusz Jagielak; Adrian P Banning; Rajesh Kharbanda; Raul Moreno; Joachim Schofer; Christina Brinkmann; Niels van Royen; Duane Pinto; Antoni Serra; Amit Segev; Arturo Giordano; Nedy Brambilla; Mauro Agnifili; Antonio Popolo Rubbio; Mattia Squillace; Jacopo Oreglia; Rudolph Tanja; James M McCabe; Alexander Abizaid; Michiel Voskuil; Rui Teles; Giuseppe Biondi Zoccai; Lars Sondergaard; Francesco Bedogni Journal: Front Cardiovasc Med Date: 2022-07-29
Authors: Hendrik Ruge; Hector A Alvarez-Covarrubias; Oliver Deutsch; Zahra Alalawi; Keti Vitanova; Rüdiger Lange Journal: Front Cardiovasc Med Date: 2022-06-02
Authors: Andrea Buono; Diego Maffeo; Giovanni Troise; Francesco Donatelli; Maurizio Tespili; Alfonso Ielasi Journal: J Clin Med Date: 2022-01-11 Impact factor: 4.241