Key result
In vitro mitral valve-in-valve implantation demonstrated better hydrodynamic performance for transcatheter prostheses 1 mm smaller than bioprostheses, except for 27-mm bioprostheses.
Why the study?
Mitral valve reoperation carries high morbidity and mortality, making transcatheter valve-in-valve implantation an alternative, but the optimal transcatheter valve sizes required hydrodynamic evaluation.
What is the optimal size of transcatheter prosthesis for mitral valve-in-valve procedures based on in vitro hydrodynamic performance?
What is the optimal size of transcatheter prosthesis for mitral valve-in-valve procedures based on in vitro hydrodynamic performance?
In vitro hydrodynamic testing suggests that for mitral valve-in-valve procedures, transcatheter prostheses 1 mm smaller than the bioprosthesis offer optimal performance, particularly in larger bioprostheses.
In vitro mitral ViV hydrodynamics may guide device choice in reoperations; leaves open need for clinical outcome validation.
INTRODUCTION: Reoperations in cardiac surgery represent a clinical challenge, particularly because of the higher rate of perioperative morbidity and mortality. Mitral valve reoperation owing to bioprosthesis dysfunction, transcatheter treatment with a prosthesis implantation over the prosthesis has emerged as an alternative, especially for patients with a previous approach. In this study, we analyzed the hydrodynamic behavior of transcatheter prosthesis implantation in conventional mitral bioprostheses through hydrodynamic tests and produced a recommendation for the size of transcatheter valve most adequate for valve-in-valve procedure. METHODS: Mitral bioprostheses were attached to a flow duplicator and different combinations of transcatheter prostheses were implanted inside. The equipment simulates the hydrodynamic behavior of the valves submitted in vitro and determines transvalvular pressures and flow parameters. RESULTS: All tests could be performed. Better hydrodynamic performance occurred for transcatheter prostheses 1 mm smaller than bioprostheses, except for the 27-mm bioprostheses. Effective valve areas (cm²) and transvalvular gradients (mmHg) were, respectively: Bioprosthesis × Inovare: 27 × 28 mm: 1.65 and 5.95/29 × 28 mm and 31 × 30 mm: 2.15 and 3.6. CONCLUSION: The mitral valve-in-valve implantation proved to be feasible in vitro. The use of 27-mm bioprostheses should be judicious, with preference for a 26-mm transcatheter valve. In the 29 and 31-mm bioprostheses, the implantation was very satisfactory, with good effective valve areas and transvalvular gradients, with preference for smaller transcatheter valves.
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Nova et al. (2021) studied Mitral bioprosthesis dysfunction. Transcatheter prosthesis implantation (valve-in-valve) was evaluated on Hydrodynamic performance (effective valve areas and transvalvular gradients). In vitro mitral valve-in-valve implantation demonstrated better hydrodynamic performance for transcatheter prostheses 1 mm smaller than bioprostheses, except for 27-mm bioprostheses.
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