Key result
TMVR VIV in different mitral bioprostheses showed marked variations, with vivMitris having the lowest peak/mean trans-mitral gradient (3.77/2.2 mmHg) and vivEpic the highest (15.5/7.09 mmHg).
Why the study?
The impact of surgical bioprosthesis design on transcatheter mitral valve replacement valve-in-valve procedures was unknown.
Does surgical bioprosthesis design impact hemodynamics and anatomic dimensions following TMVR valve-in-valve procedures in a porcine model?
Does surgical bioprosthesis design impact hemodynamics and anatomic dimensions following TMVR valve-in-valve procedures in a porcine model?
Answers are grounded in this paper and cite their sources.
Surgical mitral bioprosthesis design significantly impacts hemodynamics and transcatheter heart valve expansion during valve-in-valve procedures, which may affect clinical outcomes.
Objective Evaluate transcatheter mitral valve replacement (TMVR) valve‐in‐valve (VIV) outcomes in three different mitral bioprostheses (of comparable measured internal diameters) under stable hemodynamic and surgical conditions by bench, echocardiographic, computerized tomography (CT), and autopsy comparisons pre‐ and post‐valve implantation in a porcine model under matched controlled conditions. Background Impact of surgical bioprosthesis design on TMVR VIV procedures is unknown. Methods Fifteen similar‐sized Yorkshire pigs underwent pre‐procedural CT screening. Twelve had consistent anatomic features and underwent implantation of mitral bioprostheses. Four valves from each of three manufacturers were implanted in randomized fashion: 27‐mm Epic, 27‐mm Mosaic, and 25‐mm Mitris, followed by TMVR VIV with 26 Edwards Sapien3. Post‐VIV, suprasternal TEE studies were performed to assess hemodynamic function, followed by a gated contrast CT. After euthanasia, animals underwent necropsy for anatomic evaluation. Results All 12 animals had successful VIV implantation with no study deaths. The post vivMitris (3.77 ± 0.36)/(2.2 ± 0.25 mmHg) had the lowest peak/mean trans‐mitral gradient and the vivEpic the highest (15.5 ± 2.55)/(7.09 ± 1.13 mmHg). All THVs (transcatheter heart valves) had greatest deformation within the center of the THV frame; with the smallest waist opening area in the vivEpic (329 ± 35.8 mm2) and greatest in the vivMitris (414 ± 33.12 mm2). Bioprosthetic frames without obvious radiopaque markers resulted in the most ventricular implantation of the THV's anteroseptal frame (Epic: −4.52 ± 0.76 mm), versus the most radiopaque bioprosthesis (Mitris: −1.18 ± 2.95 mm), and higher peak LVOT gradients (Epic: 4.82 ± 1.61 mmHg; Mitris: 2.91 ± 1.47 mmHg). Conclusions The current study demonstrates marked variations in hemodynamics, THV opening area, and anatomic dimensions among measured similarly sized mitral bioprostheses. These data suggest a critical need for understanding the potential impact of variations in bioprosthesis design on TMVR VIV clinical outcomes.
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Wang et al. (2021) studied Transcatheter mitral valve replacement (TMVR) valve-in-valve (VIV) (n=12). Mitral bioprostheses (27-mm Epic, 27-mm Mosaic, and 25-mm Mitris) followed by TMVR VIV vs. Comparison among the three bioprostheses was evaluated on Hemodynamic function, THV opening area, and anatomic dimensions. TMVR VIV in different mitral bioprostheses showed marked variations, with vivMitris having the lowest peak/mean trans-mitral gradient (3.77/2.2 mmHg) and vivEpic the highest (15.5/7.09 mmHg).
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