Clinical and Hemodynamic Outcomes of Balloon-Expandable Mitral Valve-in-Valve Positioning and Asymmetric Deployment: The VIVID Registry.
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BORIS DOI
Date of Publication
November 13, 2023
Publication Type
Article
Division/Institute
Contributor
Simonato, Matheus | |
Whisenant, Brian K | |
Unbehaun, Axel | |
Kempfert, Jörg | |
Ribeiro, Henrique B | |
Kornowski, Ran | |
Erlebach, Magdalena | |
Bleiziffer, Sabine | |
Guerrero, Mayra | |
Ahmad, Yousif | |
Forrest, John K | |
Montorfano, Matteo | |
Ancona, Marco | |
Adam, Matti | |
Wienemann, Hendrik | |
Finkelstein, Ariel | |
Villablanca, Pedro | |
Codner, Pablo | |
Hildick-Smith, David | |
Ferrari, Enrico | |
Petronio, Anna Sonia | |
Shamekhi, Jasmin | |
Presbitero, Patrizia | |
Bruschi, Giuseppe | |
Rudolph, Tanja | |
Cerillo, Alfredo | |
Attias, David | |
Nejjari, Mohammed | |
Abizaid, Alexandre | |
Felippi de Sá Marchi, Maurício | |
Horlick, Eric | |
Wijeysundera, Harindra | |
Thukkani, Arun | |
Agrifoglio, Marco | |
Iadanza, Alessandro | |
Baer, L Matthew | |
Nanna, Michael G | |
Dvir, Danny |
Series
JACC: Cardiovascular Interventions
ISSN or ISBN (if monograph)
1876-7605
1936-8798
Publisher
Elsevier
Language
English
Publisher DOI
PubMed ID
37968032
Description
Background
Mitral valve-in-valve (ViV) is associated with suboptimal hemodynamics and rare left ventricular outflow tract (LVOT) obstruction.Objectives
This study aimed to determine whether device position and asymmetry are associated with these outcomes.Methods
Patients undergoing SAPIEN 3 (Edwards Lifesciences) mitral ViV included in the VIVID (Valve-in-Valve International Data) Registry were studied. Clinical endpoints are reported according to Mitral Valve Academic Research Consortium definitions. Residual mitral valve stenosis was defined as mean gradient ≥5 mm Hg. Depth of implantation (percentage of transcatheter heart valve [THV] atrial to the bioprosthesis ring) and asymmetry (ratio of 2 measures of THV height) were evaluated.Results
A total of 222 patients meeting the criteria for optimal core lab evaluation were studied (age 74 ± 11.6 years; 61.9% female; STS score = 8.3 ± 7.1). Mean asymmetry was 6.2% ± 4.4%. Mean depth of implantation was 19.0% ± 10.3% atrial. Residual stenosis was common (50%; mean gradient 5.0 ± 2.6 mm Hg). LVOT obstruction occurred in 7 cases (3.2%). Implantation depth was not a predictor of residual stenosis (OR: 1.19 [95% CI: 0.92-1.55]; P = 0.184), but more atrial implantation was protective against LVOT obstruction (0.7% vs 7.1%; P = 0.009; per 10% atrial, OR: 0.48 [95% CI: 0.24-0.98]; P = 0.044). Asymmetry was found to be an independent predictor of residual stenosis (per 10% increase, OR: 2.30 [95% CI: 1.10-4.82]; P = 0.027).Conclusions
Valve stenosis is common after mitral ViV. Asymmetry was associated with residual stenosis. Depth of implantation on its own was not associated with residual stenosis but was associated with LVOT obstruction. Technical considerations to reduce postdeployment THV asymmetry should be considered.
Mitral valve-in-valve (ViV) is associated with suboptimal hemodynamics and rare left ventricular outflow tract (LVOT) obstruction.Objectives
This study aimed to determine whether device position and asymmetry are associated with these outcomes.Methods
Patients undergoing SAPIEN 3 (Edwards Lifesciences) mitral ViV included in the VIVID (Valve-in-Valve International Data) Registry were studied. Clinical endpoints are reported according to Mitral Valve Academic Research Consortium definitions. Residual mitral valve stenosis was defined as mean gradient ≥5 mm Hg. Depth of implantation (percentage of transcatheter heart valve [THV] atrial to the bioprosthesis ring) and asymmetry (ratio of 2 measures of THV height) were evaluated.Results
A total of 222 patients meeting the criteria for optimal core lab evaluation were studied (age 74 ± 11.6 years; 61.9% female; STS score = 8.3 ± 7.1). Mean asymmetry was 6.2% ± 4.4%. Mean depth of implantation was 19.0% ± 10.3% atrial. Residual stenosis was common (50%; mean gradient 5.0 ± 2.6 mm Hg). LVOT obstruction occurred in 7 cases (3.2%). Implantation depth was not a predictor of residual stenosis (OR: 1.19 [95% CI: 0.92-1.55]; P = 0.184), but more atrial implantation was protective against LVOT obstruction (0.7% vs 7.1%; P = 0.009; per 10% atrial, OR: 0.48 [95% CI: 0.24-0.98]; P = 0.044). Asymmetry was found to be an independent predictor of residual stenosis (per 10% increase, OR: 2.30 [95% CI: 1.10-4.82]; P = 0.027).Conclusions
Valve stenosis is common after mitral ViV. Asymmetry was associated with residual stenosis. Depth of implantation on its own was not associated with residual stenosis but was associated with LVOT obstruction. Technical considerations to reduce postdeployment THV asymmetry should be considered.