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. 2021 Nov 19;17(10):848-855.
doi: 10.4244/EIJ-D-21-00254.

Outcomes of valve-in-valve transcatheter aortic valve implantation with and without bioprosthetic valve fracture

Christina Brinkmann  1 , Mohamed Abdel-Wahab, Francesco Bedogni, Oliver Daniel Bhadra, Gaetan Charbonnier, Lenard Conradi, David Hildick-Smith, Faraj Kargoli, Azeem Latib, Nicolas M Van Mieghem, Darren Mylotte, Uri Landes, Thomas Pilgrim, Jan Stripling, Maurizio Taramasso, Didier Tchétché, Luca Testa, Holger Thiele, John Webb, Stephan Windecker, Julian Witt, Peter Wohlmuth, Joachim Schofer
Affiliations

Outcomes of valve-in-valve transcatheter aortic valve implantation with and without bioprosthetic valve fracture

Christina Brinkmann et al. EuroIntervention. .

Abstract

Background: 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.

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Conflict of interest statement

M. Abdel-Wahab is a consultant to Medtronic and Boston Scientific. F. Bedogni is a consultant and proctor of Medtronic, Abbott, BSI, and Meril. L. Conradi is a consultant to Edwards, Medtronic, Boston and Abbott. D Hildick-Smith is a proctor/advisor for Abbott, Boston, Edwards, and Medtronic. A. Latib is a consultant for Medtronic, Abbott, Edwards Lifesciences, ICS and Keystone Heart. N.M. Van Mieghem has received research grant support from Abbott Vascular, Boston Scientific, Edwards Lifesciences, Abiomed, Medtronic, PulseCath BV, and Daiichi Sankyon and advisory fees from Abbott, Boston Scientific, Abiomed, Medtronic, PulseCath BV, and Daiichi Sankyo. T. Pilgrim has received research grants to the institution from Boston Scientific, Edwards Lifesciences and Biotronik; speaker fees from Boston Scientific and Biotronik, declares consultancy for HighLifeSAS (CEC), and proctoring for Medtronic. M. Taramasso is a consultant for Abbott, Boston Scientific, 4tech, and CoreMedic, and has received honoraria from Edwards Lifesciences, Mitraltech, and SwissVortex. L. Testa is a medical proctor for Boston Scientific, Meril, Concept Medical, Abbott, and Philips, and is an advisory board member and/or has received speaker fees and/or institutional research grants from BSCI, Philips, Abbott, Medtronic, Terumo, and Concept Medical. J. Webb is a consultant to and receives research funding from Edwards Lifesciences, Abbott, and Boston Scientific. S. Windecker reports research and educational grants to the institution from Abbott, Amgen, AstraZeneca, BMS, Bayer, Biotronik, Boston Scientific, Cardinal Health, Cardiovalve, CSL Behring, Daiichi Sankyo, Edwards Lifesciences, Guerbet, Infraredx, Johnson & Johnson, Medicure, Medtronic, Novartis, Polares, OrPha Suisse, Pfizer, Regeneron, Sanofi-Aventis, Sinomed, Terumo, and V-Wave. S. Windecker also serves as unpaid advisory board member and/or unpaid member of the steering/executive group of trials funded by Abbott, Abiomed, Amgen, AstraZeneca, BMS, Boston Scientific, Biotronik, Cardiovalve, Edwards Lifesciences, MedAlliance, Medtronic, Novartis, Polares, Sinomed, V-Wave and Xeltis, but has not received personal payments by pharmaceutical companies or device manufacturers. He is also a member of the steering/executive committee group of several investigator-initiated trials that receive funding by industry without impact on his personal remuneration. S. Windecker is an unpaid member of the Pfizer Research Award selection committee in Switzerland and of the Women as One Awards Committee. He is a member of the Clinical Study Group of the Deutsches Zentrum für Herz Kreislauf-Forschung and of the Advisory Board of the Australian Victorian Heart Institute. He is chairperson of the ESC Congress Program Committee and Deputy Editor of JACC CV Interventions. J. Schofer is a consultant for Edwards Lifesciences. The other authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Reduction in mean transvalvular gradients by BVF (red line) versus non-BVF (blue line) in VIV-TAVI procedures acutely and over time.
Figure 2
Figure 2
Mean gradients acutely and over time in VIV-TAVI after BVF (continuous line) or without BVF (dashed line) in SAPIEN THVs (blue) and in self-expanding THVs (red).
Figure 3
Figure 3
Mean gradients acutely and over time in VIV-TAVI after BVF (continuous line) or without BVF (dashed line) in Mitroflow SAVs (blue) and in non-Mitroflow SAVs (red).
Figure 4
Figure 4
Model-based estimates of the mean transvalvular gradient over time after BVF (red lines) and without BVF (blue lines) for patients with self-expanding THVs in non-Mitroflow SAVs (left upper panel), for patients with non-Mitroflow SAVs and SAPIEN THVs (left lower panel), for patients with Mitroflow SAV and self-expanding THVs (right upper panel) and patients with Mitroflow SAVs and SAPIEN THVs (right lower panel). Model-based estimates are adjusted to the baseline gradient.
Central illustration
Central illustration
Summary of mean transvalvular gradients in VIV-TAVI with and without BVF. The highest transvalvular gradients are expected in patients with SAPIEN in Mitroflow without BVF, the lowest in patients with Evolut in non-Mitroflow valves with BVF. In any combination, BVF reduces by approximately 6 mmHg.
See this image and copyright information in PMC

References

    1. Dvir D, Webb JG, Bleiziffer S, Pasic M, Waksman R, Kodali S, Barbanti M, Latib A, Schaefer U, Rodés-Cabau J, Treede H, Piazza N, Hildick-Smith D, Himbert D, Walther T, Hengstenberg C, Nissen H, Bekeredjian R, Presbitero P, Ferrari E, Segev A, de Weger A, Windecker S, Moat NE, Napodano M, Wilbring M, Cerillo AG, Brecker S, Tchetche D, Lefevre T, De Marco F, Fiorina C, Petronio AS, Teles RC, Testa L, Laborde JC, Leon MB, Kornowski R Valve-in-Valve International Data Registry Investigators. Transcatheter aortic valve implantation in failed bioprosthetic surgical valves. JAMA. 2014;312:162–70. - PubMed
    1. Banbury MK, Cosgrove DM 3rd, White JA, Blackstone EH, Frater RW, Okies JE. Age and valve size effect on the long-term durability of the Carpentier-Edwards aortic pericardial bioprosthesis. Ann Thorac Surg. 2001;72:753–7. doi: 10.1016/S0003-4975(01)02992-7. - DOI - PubMed
    1. Head SJ, Mokhles MM, Osnabrugge RL, Pibarot P, Mack MJ, Takkenberg JJ, Bogers AJ, Kappetein AP. The impact of prosthesis-patient mismatch on long-term survival after aortic valve replacement: a systematic review and meta-analysis of 34 observational studies comprising 27 186 patients with 133 141 patient-years. Eur Heart J. 2012;33:1518–29. doi: 10.1093/eurheartj/ehs003. - DOI - PubMed
    1. Webb JG, Mack MJ, White JM, Dvir D, Blanke P, Herrmann HC, Leipsic J, Kodali SK, Makkar R, Miller DC, Pibarot P, Pichard A, Satler LF, Svensson L, Alu MC, Suri RM, Leon MB. Transcatheter Aortic Valve Implantation Within Degenerated Aortic Surgical Bioprostheses: PARTNER 2 Valve-in-Valve Registry. J Am Coll Cardiol. 2017;69:2253–62. doi: 10.1016/j.jacc.2017.02.057. - DOI - PubMed
    1. Faerber G, Schleger S, Diab M, Breuer M, Figulla HR, Eichinger WB, Doenst T. Valve-in-valve transcatheter aortic valve implantation: the new playground for prosthesis-patient mismatch. J Interv Cardiol. 2014;27:287–92. doi: 10.1111/joic.12108. - DOI - PubMed

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