%0 Journal Article
%A Simonato, Matheus
%A Webb, John
%A Kornowski, Ran
%A Vahanian, Alec
%A Frerker, Christian
%A Nissen, Henrik
%A Bleiziffer, Sabine
%A Duncan, Alison
%A Rodes-Cabau, Josep
%A Attizzani, Guilherme F.
%A Horlick, Eric
%A Latib, Azeem
%A Bekeredjian, Raffi
%A Barbanti, Marco
%A Lefevre, Thierry
%A Cerillo, Alfredo
%A Hernandez, Jose Mara
%A Bruschi, Giuseppe
%A Spargias, Konstantinos
%A Iadanza, Alessandro
%A Brecker, Stephen
%A Palma, Jose Honorio
%A Finkelstein, Ariel
%A Abdel-Wahab, Mohamed
%A Lemos, Pedro
%A Petronio, Anna Sonia
%A Champagnac, Didier
%A Sinning, Jan-Malte
%A Salizzoni, Stefano
%A Napodano, Massimo
%A Fiorina, Claudia
%A Marzocchi, Antonio
%A Leon, Martin
%A Dvir, Danny
%T Transcatheter Replacement of Failed Bioprosthetic Valves Large Multicenter Assessment of the Effect of Implantation Depth on Hemodynamics After Aortic Valve-in-Valve
%D 2016
%@ 1941-7640
%U http://hdl.handle.net/10668/19088
%X Background-Transcatheter valve implantation inside failed bioprosthetic surgical valves (valve-in-valve [ViV]) may offer an advantage over reoperation. Supra-annular transcatheter valve position may be advantageous in achieving better hemodynamics after ViV. Our objective was to define targets for implantation that would improve hemodynamics after ViV. Methods and Results-Cases from the Valve-in-Valve International Data (VIVID) registry were analyzed using centralized core laboratory assessment blinded to clinical events. Multivariate analysis was performed to identify independent predictors of elevated postprocedural gradients (mean >= 20 mm Hg). Optimal implantation depths were defined by receiver operating characteristic curve. A total of 292 consecutive patients (age, 78.9 +/- 8.7 years; 60.3% male; 157 CoreValve Evolut and 135 Sapien XT) were evaluated. High implantation was associated with significantly lower rates of elevated gradients in comparison with low implantation (CoreValve Evolut, 15% versus 34.2%; P=0.03 and Sapien XT, 18.5% versus 43.5%; P=0.03, respectively). Optimal implantation depths were defined: CoreValve Evolut, 0 to 5 mm; Sapien XT, 0 to 2 mm (0-10% frame height); sensitivities, 91.3% and 88.5%, respectively. The strongest independent correlate for elevated gradients after ViV was device position (high: odds ratio, 0.22; confidence interval, 0.1-0.52; P=0.001), in addition to type of device used (CoreValve Evolut: odds ratio, 0.5; confidence interval, 0.28-0.88; P=0.02) and surgical valve mechanism of failure (stenosis/mixed baseline failure: odds ratio, 3.12; confidence interval, 1.51-6.45; P=0.002). Conclusions-High implantation inside failed bioprosthetic valves is a strong independent correlate of lower postprocedural gradients in both self-and balloon-expandable transcatheter valves. These clinical evaluations support specific implantation targets to optimize hemodynamics after ViV.
%K aortic valve
%K bioprosthesis
%K hemodynamics
%K multivariate analysis
%K transcatheter aortic valve replacement
%K Patient-prosthesis mismatch
%K Heart-valve
%K Surgical valves
%K Outcomes
%K Stenosis
%K Performance
%K Corevalve
%K Society
%K Surgery
%K Vitro
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