Simonato, MatheusWebb, JohnKornowski, RanVahanian, AlecFrerker, ChristianNissen, HenrikBleiziffer, SabineDuncan, AlisonRodes-Cabau, JosepAttizzani, Guilherme F.Horlick, EricLatib, AzeemBekeredjian, RaffiBarbanti, MarcoLefevre, ThierryCerillo, AlfredoHernandez, Jose MaraBruschi, GiuseppeSpargias, KonstantinosIadanza, AlessandroBrecker, StephenPalma, Jose HonorioFinkelstein, ArielAbdel-Wahab, MohamedLemos, PedroPetronio, Anna SoniaChampagnac, DidierSinning, Jan-MalteSalizzoni, StefanoNapodano, MassimoFiorina, ClaudiaMarzocchi, AntonioLeon, MartinDvir, Danny2023-02-122023-02-122016-06-011941-7640http://hdl.handle.net/10668/19088Background-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.enaortic valvebioprosthesishemodynamicsmultivariate analysistranscatheter aortic valve replacementPatient-prosthesis mismatchHeart-valveSurgical valvesOutcomesStenosisPerformanceCorevalveSocietySurgeryVitroresearch articleopen access10.1161/CIRCINTERVENTIONS.115.0036511941-7632https://www.ahajournals.org/doi/pdf/10.1161/CIRCINTERVENTIONS.115.003651378134200015