Key result
Valve-in-valve transcatheter aortic valve replacement and bioprosthetic valve fracture significantly improved mean valve gradient from 42.3 to 9.4 mmHg (p<0.001), with stable hemodynamics at 1 year.
Why the study?
Bioprosthetic valve fracture improves hemodynamic results of valve-in-valve TAVR, but long-term outcomes following the procedure are unknown.
Does bioprosthetic valve fracture (BVF) during valve-in-valve transcatheter aortic valve replacement (VIV TAVR) provide stable long-term hemodynamic improvements?
Cohort (n=139)
Yes
Does bioprosthetic valve fracture (BVF) during valve-in-valve transcatheter aortic valve replacement (VIV TAVR) provide stable long-term hemodynamic improvements?
Bioprosthetic valve fracture during valve-in-valve TAVR provides stable hemodynamics and excellent survival at 1 year, with CoreValve use predicting better hemodynamic results.
Supports the safety and hemodynamic durability of bioprosthetic valve fracture in valve-in-valve T.
BackgroundBioprosthetic valve fracture (BVF) improves the hemodynamic results of valve-in-valve transcatheter aortic valve replacement (VIV TAVR) by facilitating optimal expansion of the transcatheter heart valve (THV). Long-term outcomes following BVF are unknown.MethodsConsecutive cases of VIV TAVR and BVF (n = 139) performed at 11 sites were analyzed retrospectively. Hemodynamic measurements and aortic valve area (AVA) were assessed during the procedure and by echocardiography at 30-day and 1-year follow-up.ResultsVIV TAVR and BVF resulted in significant improvements in mean valve gradient (42.3 ± 17.1 vs. 9.4 ± 5.8 mmHg, p < 0.001) and AVA (0.8 ± 0.4 vs. 1.8 ± 0.7 cm2, p < 0.001) compared with baseline. Mortality was 2.3% at 30 days and 8.7% at 1-year. In adjusted models, mean valve gradient was higher (+5.1 [3.7, 6.5] mmHg, p < 0.001) and AVA was lower (−0.3 [−0.4, −0.2] cm2, p < 0.001) at 1 month as compared to post-procedure. Between 30 days and 1 year, no significant changes in mean valve gradient (+1.4 [−0.5, 3.4] mmHg, p = 0.15) or AVA (−0.1 [−0.3, 0.03] cm2, p = 0.11) were observed. In a multivariable analysis, use of a CoreValve (compared with a SAPIEN) THV was an independent predictor of a lower mean valve gradient at 1 year (−6.0 mmHg, p = 0.01).ConclusionSurvival is excellent following VIV TAVR and BVF and valve hemodynamics are stable between 30-day and 1-year follow-up. CoreValve use is a predictor of better hemodynamic results following VIV TAVR and BVF.Abbreviations: VIV TAVR: valve-in-valve transcatheter aortic valve replacement; THV: transcatheter heart valve; BSV: bioprosthetic surgical valve; PPM: patient prosthesis mismatch; BVF: bioprosthetic valve fracture; IQR: interquartile range; LVEF: left ventricular ejection fraction; AVA: aortic valve area; STS PROM: Society of Thoracic Surgeons predicted risk of mortality
No takes yet. Share an insight, caveat, or question.
Chhatriwalla et al. (2021) conducted a cohort in Valve-in-valve transcatheter aortic valve replacement (n=139). Valve-in-valve transcatheter aortic valve replacement and bioprosthetic valve fracture vs. Baseline was evaluated on Mean valve gradient (p=<0.001). Valve-in-valve transcatheter aortic valve replacement and bioprosthetic valve fracture significantly improved mean valve gradient from 42.3 to 9.4 mmHg (p<0.001), with stable hemodynamics at 1 year.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: