Brinkmann, ChristinaChristinaBrinkmannAbdel-Wahab, MohamedMohamedAbdel-WahabBedogni, FrancescoFrancescoBedogniBhadra, Oliver DanielOliver DanielBhadraCharbonnier, GaetanGaetanCharbonnierConradi, LenardLenardConradiHildick-Smith, DavidDavidHildick-SmithKargoli, FarajFarajKargoliLatib, AzeemAzeemLatibVan Mieghem, Nicolas MNicolas MVan MieghemMylotte, DarrenDarrenMylotteLandes, UriUriLandesPilgrim, ThomasThomasPilgrimStripling, JanJanStriplingTaramasso, MaurizioMaurizioTaramassoTchétché, DidierDidierTchétchéTesta, LucaLucaTestaThiele, HolgerHolgerThieleWebb, JohnJohnWebbWindecker, StephanStephanWindeckerWitt, JulianJulianWittWohlmuth, PeterPeterWohlmuthSchofer, JoachimJoachimSchofer2024-10-072024-10-072021-11-19https://boris-portal.unibe.ch/handle/20.500.12422/59024BACKGROUND 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.en600 - Technology::610 - Medicine & healtharticle10.48350/1631993403102210.4244/EIJ-D-21-00254