Bioprosthetic valve fracture after valve-in-valve intervention yielded superior valve expansion and lower transvalvular gradients in SAPIEN 3 (5.6 vs 15.5 mmHg) and ACURATE neo valves.
Does bioprosthetic valve fracture performed after versus before valve-in-valve intervention improve transvalvular gradients and THV expansion in a bench model?
Bench testing demonstrates that performing bioprosthetic valve fracture after, rather than before, valve-in-valve intervention yields superior transcatheter heart valve expansion and lower transvalvular gradients.
AIMS: Bioprosthetic valve fracture (BVF) may improve transvalvular gradients and transcatheter heart valve (THV) expansion during VIV interventions. However, the optimal timing of BVF is unknown. We assessed the impact of timing of BVF (before versus after) for valve-in-valve (VIV) intervention, on hydrodynamic function and THV expansion. METHODS AND RESULTS: Three THV designs were assessed, a 23 mm SAPIEN 3 (S3), small ACURATE neo (ACn) and 23 mm Evolut R, deployed into 21 mm Mitroflow bioprosthetic surgical valves. We evaluated each THV in three groups: 1) no BVF, 2) BVF before VIV, and 3) BVF after VIV. Hydrodynamic testing was performed using a pulse duplicator to ISO 5840:2013 standard. Transvalvular gradients were lower when BVF was performed after VIV for the S3 (no BVF 15.5 mmHg, BVF before VIV 8.0 mmHg, BVF after VIV 5.6 mmHg), and the ACn (no BVF 9.8 mmHg, BVF before VIV 8.4 mmHg, BVF after VIV 5.1 mmHg). Transvalvular gradients were similar for the Evolut R, irrespective of performance of BVF or timing of BVF. BVF performed after VIV resulted in better expansion in all three THV designs. The ACn and Evolut R samples all had a mild degree of pinwheeling, and BVF timing did not impact on pinwheeling severity. The S3 samples had severe pinwheeling with no BVF, and significant improvement in pinwheeling when BVF was performed after VIV. CONCLUSIONS: BVF performed after VIV was associated with superior THV expansion in all three THV designs tested, with lower residual transvalvular gradients in the S3 and ACn THVs. The Evolut R had similar hydrodynamic performance irrespective of BVF timing. Timing of BVF has potential implications on THV function.
Sathananthan et al. (Sun,) conducted a other in Bioprosthetic valve fracture during valve-in-valve intervention. Bioprosthetic valve fracture (BVF) after VIV vs. No BVF or BVF before VIV was evaluated on Hydrodynamic function (transvalvular gradients) and THV expansion. Bioprosthetic valve fracture after valve-in-valve intervention yielded superior valve expansion and lower transvalvular gradients in SAPIEN 3 (5.6 vs 15.5 mmHg) and ACURATE neo valves.
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