Key result
Bioprosthetic valve fracturing during ViV-TAVI shows no hemodynamic benefit over standard postdilatation.
Why the study?
Data comparing clinical and hemodynamic outcomes of bioprosthetic valve fracturing and standard-postdilatation during ViV-TAVI were lacking.
Does bioprosthetic valve fracturing improve hemodynamic outcomes compared to standard postdilatation in patients undergoing valve-in-valve TAVI for failing Perimount aortic bioprostheses?
Observational (n=240)
Yes
Does bioprosthetic valve fracturing improve hemodynamic outcomes compared to standard postdilatation in patients undergoing valve-in-valve TAVI for failing Perimount aortic bioprostheses?
In patients undergoing ViV-TAVI within a Perimount surgical aortic bioprosthesis, bioprosthetic valve fracturing did not yield superior hemodynamics compared to standard postdilatation.
Answers are grounded in this paper and cite their sources.
Bioprosthetic valve fracturing yields no hemodynamic superiority versus postdilatation; leaves open its role in other valves or endpoints.
BACKGROUND: Data comparing clinical and hemodynamic outcomes of bioprosthetic valve fracturing (BVF) and "standard"-postdilatation during valve-in-valve transcatheter heart valve implantation (ViV-TAVI) are lacking. The authors aimed to analyze hemodynamic and clinical outcomes of BVF compared to "standard"-postdilatation during ViV-TAVI. METHODS: The REDUCE registry included patients who underwent ViV-TAVI within a Perimount surgical aortic valve bioprosthesis (Edwards Lifesciences, USA). Procedures were categorized to no postdilatation, "standard"-postdilatation and BVF. Hemodynamic and clinical outcomes at 30 days were collected and compared. A linear regression model was built to predict mean aortic gradient after ViV-TAVI. RESULTS: A total of 240 patients from six European sites were included. Median age was 78 years [IQR 70; 83], logistic EuroSCORE calculated 20.0%[IQR 12.2; 33.1] and 159 patients (66%) were male. One hundred fourty-four Perimount valves (60%) had a true internal diameter (ID) ≤ 21 mm. Self-expanding valves (SEV) and ballon-expandable valves (BEV) were used in 60% and 40% of cases, respectively. One hundred sixteen procedures (48%) were executed without postdilatation, in 88 procedures (37%) "standard"-postdilatation and in 36 procedures (15%) BVF was used. 30-day survival was 93.3%. VARC-3 device success at 30 days was 71%. A multivariable regression analysis of the mean aortic gradient after ViV-TAVI showed a significant association with surgical valve size (-0.84 mmHg, p = 0.001; per 1 mm surgical valve size increase), execution of postdilatation (-3.25 mmHg, p = 0.007) and type of transcatheter heart valve (SEV: -7.31 mmHg, p < 0.001). CONCLUSIONS: When performing ViV-TAVI within a Perimount surgical aortic bioprosthesis with a true ID ≤ 21 mm, the hemodynamic valve performance is most optimal when implanting a SEV-TAV and when postdilating the TAV-in-SAV complex. BVF did not result in superior hemodynamics compared to "standard"-postdilatation.
No takes yet. Share an insight, caveat, or question.
Ruge et al. (2025) conducted an observational in Failing Perimount aortic bioprostheses (n=240). Bioprosthetic valve fracturing (BVF) vs. "standard"-postdilatation or no postdilatation was evaluated on Mean aortic gradient after ViV-TAVI. During valve-in-valve TAVI, bioprosthetic valve fracturing did not result in superior hemodynamics compared to standard postdilatation, which reduced mean aortic gradient (-3.25 mmHg, p=0.007).
Synapse has enriched 10 related papers. Consider them for comparative context: