TY - JOUR
T1 - Transcatheter replacement of failed bioprosthetic valves
T2 - Large multicenter assessment of the effect of implantation depth on hemodynamics after aortic valve-in-valve
AU - Simonato, Matheus
AU - Webb, John
AU - Kornowski, Ran
AU - Vahanian, Alec
AU - Frerker, Christian
AU - Nissen, Henrik
AU - Bleiziffer, Sabine
AU - Duncan, Alison
AU - Rodés-Cabau, Josep
AU - Attizzani, Guilherme F.
AU - Horlick, Eric
AU - Latib, Azeem
AU - Bekeredjian, Raffi
AU - Barbanti, Marco
AU - Lefevre, Thierry
AU - Cerillo, Alfredo
AU - Hernández, José María
AU - Bruschi, Giuseppe
AU - Spargias, Konstantinos
AU - Iadanza, Alessandro
AU - Brecker, Stephen
AU - Palma, José Honório
AU - Finkelstein, Ariel
AU - Abdel-Wahab, Mohamed
AU - Lemos, Pedro
AU - Petronio, Anna Sonia
AU - Champagnac, Didier
AU - Sinning, Jan Malte
AU - Salizzoni, Stefano
AU - Napodano, Massimo
AU - Fiorina, Claudia
AU - Marzocchi, Antonio
AU - Leon, Martin
AU - Dvir, Danny
N1 - Publisher Copyright:
© 2016 American Heart Association, Inc.
PY - 2016/6/1
Y1 - 2016/6/1
N2 - 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.
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.
KW - aortic valve
KW - bioprosthesis
KW - hemodynamics
KW - multivariate analysis
KW - transcatheter aortic valve replacement
UR - http://www.scopus.com/inward/record.url?scp=84975701795&partnerID=8YFLogxK
U2 - 10.1161/CIRCINTERVENTIONS.115.003651
DO - 10.1161/CIRCINTERVENTIONS.115.003651
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C2 - 27301396
AN - SCOPUS:84975701795
SN - 1941-7640
VL - 9
JO - Circulation: Cardiovascular Interventions
JF - Circulation: Cardiovascular Interventions
IS - 6
M1 - e003651
ER -