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

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

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.

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