The Official Journal of EuroPCR and the European Association of Percutaneous Coronary Interventions (EAPCI)

Outcomes of Valve-in-Valve Transcatheter Aortic Valve Implantation with and without Bioprosthetic Valve Fracture

DOI: 10.4244/EIJ-D-21-00254

1. MVZ Department Structural Heart Disease, Asklepios St. Georg, Hamburg, Germany, 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, Germany
5. Clinique Pasteur, Toulouse, France
6. Sussex Cardiac Centre, Brighton & Sussex University Hospitals, UK
7. Montefiore Medical Center / Albert Einstein College of Medicine, New York, 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, Switzerland
14. St. Paul’s Hospital, Vancouver, BC, Canada
15. Asklepios ProResearch, Hamburg, Germany

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

Aims: 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- and 68.4% in the control-group (p<0.001). The mean transvalvular gradient decreased from 37 ± 13mmHg to 10.8 ± 5.9mmHg (p<0.001) in the BVF- and from 35 ± 16mmHg to 15.8 ± 6.8mmHg (p<0.001) in the control-group with a significantly higher final gradient in control (p<0.001). The transvalvular gradients did not significantly change over time. In-hospital major adverse events occurred in 3.7% in BVF- and 7.6% in 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 for 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 for 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.

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