RT Journal Article
T1 Transcatheter Replacement of Failed Bioprosthetic Valves Large Multicenter Assessment of the Effect of Implantation Depth on Hemodynamics After Aortic Valve-in-Valve
A1 Simonato, Matheus
A1 Webb, John
A1 Kornowski, Ran
A1 Vahanian, Alec
A1 Frerker, Christian
A1 Nissen, Henrik
A1 Bleiziffer, Sabine
A1 Duncan, Alison
A1 Rodes-Cabau, Josep
A1 Attizzani, Guilherme F.
A1 Horlick, Eric
A1 Latib, Azeem
A1 Bekeredjian, Raffi
A1 Barbanti, Marco
A1 Lefevre, Thierry
A1 Cerillo, Alfredo
A1 Hernandez, Jose Mara
A1 Bruschi, Giuseppe
A1 Spargias, Konstantinos
A1 Iadanza, Alessandro
A1 Brecker, Stephen
A1 Palma, Jose Honorio
A1 Finkelstein, Ariel
A1 Abdel-Wahab, Mohamed
A1 Lemos, Pedro
A1 Petronio, Anna Sonia
A1 Champagnac, Didier
A1 Sinning, Jan-Malte
A1 Salizzoni, Stefano
A1 Napodano, Massimo
A1 Fiorina, Claudia
A1 Marzocchi, Antonio
A1 Leon, Martin
A1 Dvir, Danny
K1 aortic valve
K1 bioprosthesis
K1 hemodynamics
K1 multivariate analysis
K1 transcatheter aortic valve replacement
K1 Patient-prosthesis mismatch
K1 Heart-valve
K1 Surgical valves
K1 Outcomes
K1 Stenosis
K1 Performance
K1 Corevalve
K1 Society
K1 Surgery
K1 Vitro
AB 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.
PB Lippincott williams & wilkins
SN 1941-7640
YR 2016
FD 2016-06-01
LK http://hdl.handle.net/10668/19088
UL http://hdl.handle.net/10668/19088
LA en
DS RISalud
RD Apr 6, 2025