Interventions for valvular disease and heart failure

Outcomes of valve-in-valve transcatheter aortic valve implantation with and without bioprosthetic valve fracture

EuroIntervention 2021;17:848-855. DOI: 10.4244/EIJ-D-21-00254

Christina Brinkmann
Christina Brinkmann1, MD; Mohamed Abdel-Wahab2, MD; Francesco Bedogni3, MD; Oliver Daniel Bhadra4, MD; Gaetan Charbonnier5, MD; Lenard Conradi4, MD, PhD; David Hildick-Smith6, MD, PhD; Faraj Kargoli7, MD, MPH; Azeem Latib7, MD, PhD; Nicolas M. Van Mieghem8, MD, PhD; Darren Mylotte9, MD; Uri Landes10, MD; Thomas Pilgrim11, MD; Jan Stripling12, MD; Maurizio Taramasso13, MD; Didier Tchétché5, MD; Luca Testa3, MD, PhD; Holger Thiele2, MD, PhD; John Webb14, MD, PhD; Stephan Windecker11, MD; Julian Witt12, MD; Peter Wohlmuth15, PhD; Joachim Schofer1, MD, PhD
1. MVZ Department Structural Heart Disease, Asklepios St. Georg, Hamburg, Germany; 2. Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany; 3. IRCCS Policlinico San Donato, Milan, Italy; 4. Universitäres Herz- und Gefäßzentrum Hamburg, Hamburg, Germany; 5. Clinique Pasteur, Toulouse, France; 6. Sussex Cardiac Centre, Brighton & Sussex University Hospitals, Brighton, United Kingdom; 7. Montefiore Medical Center / Albert Einstein College of Medicine, New York, NY, USA; 8. Erasmus MC, Rotterdam, the Netherlands; 9. Bon Secours Hospital, Galway, Ireland; 10. Rabin Medical Center, Tel-Aviv University, Tel-Aviv, Israel; 11. Inselspital Bern, Bern University Hospital, Bern, Switzerland; 12. Albertinen Heart Center, Hamburg, Germany; 13. Universitätsspital Zürich, Zürich, Switzerland; 14. St. Paul’s Hospital, Vancouver, BC, Canada; 15. Asklepios ProResearch, Hamburg, Germany

Background: Bioprosthetic valve fracture (BVF) is a technique to reduce gradients in valve-in-valve transcatheter aortic valve implantation (VIV-TAVI) procedures. The outcome of VIV-TAVI with BVF has not been compared with VIV-TAVI without BVF.

Aims: The aim of this study was to evaluate the outcome of VIV-TAVI with BVF compared to VIV-TAVI without BVF.

Methods: In total, 81 cases of BVF VIV-TAVI (BVF group) from 14 centres were compared to 79 cases of VIV-TAVI without BVF (control group).

Results: VARC-2-defined device success was 93% in the BVF group and 68.4% in the control group (p<0.001). The mean transvalvular gradient decreased from 37±13 mmHg to 10.8±5.9 mmHg (p<0.001) in the BVF group and from 35±16 mmHg to 15.8±6.8 mmHg (p<0.001) in the control group with a significantly higher final gradient in the control group (p<0.001). The transvalvular gradients did not change significantly over time. In-hospital major adverse events occurred in 3.7% in the BVF group and 7.6% in the control group (p=0.325). A linear mixed model identified BVF, self-expanding transcatheter heart valves (THVs) and other surgical aortic valve (SAV) types other than Mitroflow as predictors of lower transvalvular gradients.

Conclusions: Compared to VIV-TAVI alone, VIV-TAVI with BVF resulted in a significantly lower transvalvular gradient acutely and at follow-up. Independent predictors of lower gradients were the use of self-expanding THVs and the treatment of SAVs other than Mitroflow, irrespective of BVF performance. BVF significantly reduced the gradient independently from transcatheter or surgical valve type.

Sign in to read and download the full article

Forgot your password?

No account yet?
Sign up for free!

Create my pcr account

Join us for free and access thousands of articles from EuroIntervention, as well as presentations, videos, cases from

aortic stenosisdegenerative valvetavivalve-in-valve
Read next article
Repeat transcatheter aortic valve implantation and implications for transcatheter heart valve performance: insights from bench testing

Latest news