Outcomes of valve-in-valve transcatheter aortic valve implantation with and without bioprosthetic valve fracture.
Publisher DOI
PubMed ID
34031022
Abstract
BACKGROUND
Bioprosthetic valve fracture (BVF) is a technique to reduce gradients in valve-in-valve transcatheter aortic valve implantation (VIV-TAVI) procedures. The outcome of VIV-TAVI with BVF has not been compared with VIV-TAVI without BVF.
AIMS
The aim of this study was 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 group and 68.4% in the control group (p<0.001). The mean transvalvular gradient decreased from 37±13 mmHg to 10.8±5.9 mmHg (p<0.001) in the BVF group and from 35±16 mmHg to 15.8±6.8 mmHg (p<0.001) in the control group with a significantly higher final gradient in the control group (p<0.001). The transvalvular gradients did not change significantly over time. In-hospital major adverse events occurred in 3.7% in the BVF group and 7.6% in the 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 of 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 of 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.
Bioprosthetic valve fracture (BVF) is a technique to reduce gradients in valve-in-valve transcatheter aortic valve implantation (VIV-TAVI) procedures. The outcome of VIV-TAVI with BVF has not been compared with VIV-TAVI without BVF.
AIMS
The aim of this study was 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 group and 68.4% in the control group (p<0.001). The mean transvalvular gradient decreased from 37±13 mmHg to 10.8±5.9 mmHg (p<0.001) in the BVF group and from 35±16 mmHg to 15.8±6.8 mmHg (p<0.001) in the control group with a significantly higher final gradient in the control group (p<0.001). The transvalvular gradients did not change significantly over time. In-hospital major adverse events occurred in 3.7% in the BVF group and 7.6% in the 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 of 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 of 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.
Date Issued
2021-11-19
Publication Type
Article
Subject(s)
Language(s)
en
Author(s)
Brinkmann, Christina | |
Abdel-Wahab, Mohamed | |
Bedogni, Francesco | |
Bhadra, Oliver Daniel | |
Charbonnier, Gaetan | |
Conradi, Lenard | |
Hildick-Smith, David | |
Kargoli, Faraj | |
Latib, Azeem | |
Van Mieghem, Nicolas M | |
Mylotte, Darren | |
Landes, Uri | |
Stripling, Jan | |
Taramasso, Maurizio | |
Tchétché, Didier | |
Testa, Luca | |
Thiele, Holger | |
Webb, John | |
Witt, Julian | |
Wohlmuth, Peter | |
Schofer, Joachim |
Additional Credits
Journal
EuroIntervention
Publisher
Europa Digital & Publishing
ISSN
1774-024X
Access(Rights)
restricted