TY - JOUR
T1 - Clinical and Hemodynamic Outcomes of Balloon-Expandable Mitral Valve-in-Valve Positioning and Asymmetric Deployment
T2 - The VIVID Registry
AU - Simonato, Matheus
AU - Whisenant, Brian K.
AU - Unbehaun, Axel
AU - Kempfert, Jörg
AU - Ribeiro, Henrique B.
AU - Kornowski, Ran
AU - Erlebach, Magdalena
AU - Bleiziffer, Sabine
AU - Windecker, Stephan
AU - Pilgrim, Thomas
AU - Tomii, Daijiro
AU - Guerrero, Mayra
AU - Ahmad, Yousif
AU - Forrest, John K.
AU - Montorfano, Matteo
AU - Ancona, Marco
AU - Adam, Matti
AU - Wienemann, Hendrik
AU - Finkelstein, Ariel
AU - Villablanca, Pedro
AU - Codner, Pablo
AU - Hildick-Smith, David
AU - Ferrari, Enrico
AU - Petronio, Anna Sonia
AU - Shamekhi, Jasmin
AU - Presbitero, Patrizia
AU - Bruschi, Giuseppe
AU - Rudolph, Tanja
AU - Cerillo, Alfredo
AU - Attias, David
AU - Nejjari, Mohammed
AU - Abizaid, Alexandre
AU - Felippi de Sá Marchi, Maurício
AU - Horlick, Eric
AU - Wijeysundera, Harindra
AU - Andreas, Martin
AU - Thukkani, Arun
AU - Agrifoglio, Marco
AU - Iadanza, Alessandro
AU - Baer, L. Matthew
AU - Nanna, Michael G.
AU - Dvir, Danny
N1 - Publisher Copyright:
© 2023 American College of Cardiology Foundation
PY - 2023/11/13
Y1 - 2023/11/13
N2 - Background: Mitral valve-in-valve (ViV) is associated with suboptimal hemodynamics and rare left ventricular outflow tract (LVOT) obstruction. Objectives: This study aimed to determine whether device position and asymmetry are associated with these outcomes. Methods: Patients undergoing SAPIEN 3 (Edwards Lifesciences) mitral ViV included in the VIVID (Valve-in-Valve International Data) Registry were studied. Clinical endpoints are reported according to Mitral Valve Academic Research Consortium definitions. Residual mitral valve stenosis was defined as mean gradient ≥5 mm Hg. Depth of implantation (percentage of transcatheter heart valve [THV] atrial to the bioprosthesis ring) and asymmetry (ratio of 2 measures of THV height) were evaluated. Results: A total of 222 patients meeting the criteria for optimal core lab evaluation were studied (age 74 ± 11.6 years; 61.9% female; STS score = 8.3 ± 7.1). Mean asymmetry was 6.2% ± 4.4%. Mean depth of implantation was 19.0% ± 10.3% atrial. Residual stenosis was common (50%; mean gradient 5.0 ± 2.6 mm Hg). LVOT obstruction occurred in 7 cases (3.2%). Implantation depth was not a predictor of residual stenosis (OR: 1.19 [95% CI: 0.92-1.55]; P = 0.184), but more atrial implantation was protective against LVOT obstruction (0.7% vs 7.1%; P = 0.009; per 10% atrial, OR: 0.48 [95% CI: 0.24-0.98]; P = 0.044). Asymmetry was found to be an independent predictor of residual stenosis (per 10% increase, OR: 2.30 [95% CI: 1.10-4.82]; P = 0.027). Conclusions: Valve stenosis is common after mitral ViV. Asymmetry was associated with residual stenosis. Depth of implantation on its own was not associated with residual stenosis but was associated with LVOT obstruction. Technical considerations to reduce postdeployment THV asymmetry should be considered.
AB - Background: Mitral valve-in-valve (ViV) is associated with suboptimal hemodynamics and rare left ventricular outflow tract (LVOT) obstruction. Objectives: This study aimed to determine whether device position and asymmetry are associated with these outcomes. Methods: Patients undergoing SAPIEN 3 (Edwards Lifesciences) mitral ViV included in the VIVID (Valve-in-Valve International Data) Registry were studied. Clinical endpoints are reported according to Mitral Valve Academic Research Consortium definitions. Residual mitral valve stenosis was defined as mean gradient ≥5 mm Hg. Depth of implantation (percentage of transcatheter heart valve [THV] atrial to the bioprosthesis ring) and asymmetry (ratio of 2 measures of THV height) were evaluated. Results: A total of 222 patients meeting the criteria for optimal core lab evaluation were studied (age 74 ± 11.6 years; 61.9% female; STS score = 8.3 ± 7.1). Mean asymmetry was 6.2% ± 4.4%. Mean depth of implantation was 19.0% ± 10.3% atrial. Residual stenosis was common (50%; mean gradient 5.0 ± 2.6 mm Hg). LVOT obstruction occurred in 7 cases (3.2%). Implantation depth was not a predictor of residual stenosis (OR: 1.19 [95% CI: 0.92-1.55]; P = 0.184), but more atrial implantation was protective against LVOT obstruction (0.7% vs 7.1%; P = 0.009; per 10% atrial, OR: 0.48 [95% CI: 0.24-0.98]; P = 0.044). Asymmetry was found to be an independent predictor of residual stenosis (per 10% increase, OR: 2.30 [95% CI: 1.10-4.82]; P = 0.027). Conclusions: Valve stenosis is common after mitral ViV. Asymmetry was associated with residual stenosis. Depth of implantation on its own was not associated with residual stenosis but was associated with LVOT obstruction. Technical considerations to reduce postdeployment THV asymmetry should be considered.
KW - SAPIEN 3
KW - depth of implantation
KW - left ventricular outflow tract obstruction
KW - mitral valve-in-valve
KW - positioning
KW - residual stenosis
UR - http://www.scopus.com/inward/record.url?scp=85175444685&partnerID=8YFLogxK
U2 - 10.1016/j.jcin.2023.08.047
DO - 10.1016/j.jcin.2023.08.047
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C2 - 37968032
AN - SCOPUS:85175444685
SN - 1936-8798
VL - 16
SP - 2615
EP - 2627
JO - JACC: Cardiovascular Interventions
JF - JACC: Cardiovascular Interventions
IS - 21
ER -