Key result
A high implantation position of transcatheter heart valves in rapid deployment valves achieved lower mean pressure gradients and higher effective orifice areas compared to a lower position.
Why the study?
Does a higher implantation position improve hydrodynamic performance of transcatheter heart valves in small rapid deployment valves compared to a lower position?
Does a higher implantation position improve hydrodynamic performance of transcatheter heart valves in small rapid deployment valves compared to a lower position?
In an in vitro model, a higher implantation position for transcatheter heart valves in small rapid deployment valves yields superior hydrodynamic performance and leaflet function.
Higher implantation may enhance hydrodynamics in small rapid deployment valves; leaves open clinical translation and outcomes.
AIMS: The aim of this study was to determine the best functional position of a transcatheter heart valve (THV) implanted as a valve-in-valve (ViV) procedure in small rapid deployment valves (RDV) in an in vitro model. METHODS AND RESULTS: A 21 mm Perceval, Enable or INTUITY RDV was mounted into a pulse duplicator and a 23 mm balloon-expandable or a self-expanding THV was deployed (valve-in-valve) in two different positions. Under physiological hydrodynamic conditions, the performance of the THV was characterised by mean transvalvular pressure gradient (MPG), effective orifice area (EOA) and regurgitation volume (RV). Leaflet kinematics were assessed with high-speed video recordings, and X-ray images were acquired. All THV/RDV combinations met ISO requirements regarding hydrodynamic performance. In most cases, the higher position of the THV performed better than the lower one in terms of a lower MPG and increased EOA. Leaflet motion of the implanted THV was impaired in the lower position. In contrast, regurgitation volumes were relatively small and similar, regardless of the THV position. CONCLUSIONS: ViV implantation of a THV in a small RDV yielded satisfactory hydrodynamic results. In most cases, a high implantation position achieved lower MPG, higher EOA and a reduced risk of impaired THV leaflet function. Fluoroscopy images of the best functional ViV positions are presented as a blueprint for patient procedures.
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Schäfer et al. (2017) studied Valve-in-valve procedure. High implantation position of transcatheter heart valve vs. Low implantation position was evaluated on Mean transvalvular pressure gradient, effective orifice area, and regurgitation volume. A high implantation position of transcatheter heart valves in rapid deployment valves achieved lower mean pressure gradients and higher effective orifice areas compared to a lower position.
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