Transcatheter replacement of failed bioprosthetic valves
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 i...
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| Main Authors: | , |
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| Format: | Article (Journal) |
| Language: | English |
| Published: |
April 29, 2016
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| In: |
Circulation. Cardiovascular interventions
Year: 2016, Volume: 9, Issue: 6 |
| ISSN: | 1941-7632 |
| DOI: | 10.1161/CIRCINTERVENTIONS.115.003651 |
| Online Access: | Verlag, Volltext: https://doi.org/10.1161/CIRCINTERVENTIONS.115.003651 Verlag, Volltext: https://www.ahajournals.org/doi/full/10.1161/CIRCINTERVENTIONS.115.003651 
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| Author Notes: | Matheus Simonato; John Webb, MD; Ran Kornowski, MD; Alec Vahanian, MD; Christian Frerker, MD; Henrik Nissen, MD; Sabine Bleiziffer, MD; Alison Duncan, MD; Josep Rodés-Cabau, MD; Guilherme F. Attizzani, MD; Eric Horlick, MD; Azeem Latib, MD; Raffi Bekeredjian, MD; Marco Barbanti, MD; Thierry Lefevre, MD; Alfredo Cerillo, MD; José María Hernández, MD; Giuseppe Bruschi, MD; Konstantinos Spargias, MD; Alessandro Iadanza, MD; Stephen Brecker, MD; José Honório Palma, MD; Ariel Finkelstein, MD; Mohamed Abdel-Wahab, MD; Pedro Lemos, MD; Anna Sonia Petronio, MD; Didier Champagnac, MD; Jan-Malte Sinning, MD; Stefano Salizzoni, MD; Massimo Napodano, MD; Claudia Fiorina, MD; Antonio Marzocchi, MD; Martin Leon, MD; Danny Dvir, MD |
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| 245 | 1 | 0 | |a Transcatheter replacement of failed bioprosthetic valves |c Matheus Simonato; John Webb, MD; Ran Kornowski, MD; Alec Vahanian, MD; Christian Frerker, MD; Henrik Nissen, MD; Sabine Bleiziffer, MD; Alison Duncan, MD; Josep Rodés-Cabau, MD; Guilherme F. Attizzani, MD; Eric Horlick, MD; Azeem Latib, MD; Raffi Bekeredjian, MD; Marco Barbanti, MD; Thierry Lefevre, MD; Alfredo Cerillo, MD; José María Hernández, MD; Giuseppe Bruschi, MD; Konstantinos Spargias, MD; Alessandro Iadanza, MD; Stephen Brecker, MD; José Honório Palma, MD; Ariel Finkelstein, MD; Mohamed Abdel-Wahab, MD; Pedro Lemos, MD; Anna Sonia Petronio, MD; Didier Champagnac, MD; Jan-Malte Sinning, MD; Stefano Salizzoni, MD; Massimo Napodano, MD; Claudia Fiorina, MD; Antonio Marzocchi, MD; Martin Leon, MD; Danny Dvir, MD |
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| 520 | |a 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. | ||
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