Impact of Pre-Existing Prosthesis-Patient Mismatch on Survival Following Aortic Valve-in-Valve Procedures

Pîbarot, Philippe; Simonato, Matheus; Barbanti, Marco; Linke, Axel; Kornowski, Ran; Rudolph, Tanja K.; Spence, Mark S.; Moat, Neil; Aldea, Gabriel S.; Mennuni, Marco; Iadanza, Alessandro; Amrane, Hafid; Gaia, Diego Felipe; Kim, Won Keun; Napodano, Massimo; Baumbach, Hardy; Finkelstein, Ariel; Kobayashi, Junjiro; Brecker, Stephen; Don, Creighton W.; Cerillo, Alfredo Giuseppe; Unbehaun, Axel; Attias, David; Nejjari, Mohammed; Jones, Noah; Fiorina, Claudia; Tchétché, Didier; Philippart, Raphaël; Spargias, Konstantinos; Hernández, José M. de la Torre; Latib, Azeem; Dvir, Danny

doi:10.1016/j.jcin.2017.08.039

Cited by 91 publications

(48 citation statements)

References 26 publications

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“…Device success was lower in patients with bicuspid aortic valve, as has previously been described . Device success was also lower in patients undergoing valve‐in‐valve procedures, driven by a high incidence of patient–prosthesis mismatch, consistent with previous reports …”

Section: Discussionsupporting

confidence: 90%

Initial experience of a self‐expanding transcatheter aortic valve with an outer pericardial wrap: The United Kingdom and Ireland Implanters' registry

Dowling

Firoozi

Panoulas

et al. 2019

Cathet Cardio Intervent

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Objectives The United Kingdom and Ireland Implanters' registry is a multicenter registry which reports on real‐world experience with new transcatheter heart valves. Background The Evolut PRO (Medtronic, Minneapolis, MN) transcatheter aortic valve is a self‐expanding transcatheter aortic valve with an outer pericardial wrap, designed to minimize paravalvular regurgitation. Methods Between July 2017 and December 2018, clinical, procedural, and 30‐day outcome data were prospectively collected from all patients receiving the Evolut PRO valve across nine participating centers in the United Kingdom and Ireland. The primary efficacy outcome was the Valve Academic Research Consortium‐2 (VARC‐2)‐defined endpoint of device success. The primary safety outcome was the VARC‐2‐defined composite endpoint of early safety at 30 days. Results A total of 317 patients underwent implantation. Mean age was 81.8 ± 6.4 years and Society of Thoracic Surgeons Predicted Risk of Mortality Score 5.5 ± 1.8%. Iliofemoral access was used in 99.1% of patients. Device success was 91.2%. Mean gradient was 7.6 ± 4.7 mmHg and effective orifice area 1.9 ± 0.7 cm2. The incidence of moderate paravalvular regurgitation was 1.7% and there was no severe paravalvular regurgitation. A new permanent pacemaker was implanted in 17.8% of patients without a pacemaker at baseline. Early safety was demonstrated in 92.7%. At 30 days, all‐cause mortality was 0.6%, stroke 3.8%, and major vascular complication 2.8%. Conclusions Real‐world experience of the Evolut PRO transcatheter aortic valve demonstrated favorable procedural success, safety, valve function, and incidence of new permanent pacemaker implantation.

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Section: Discussionsupporting

confidence: 90%

Initial experience of a self‐expanding transcatheter aortic valve with an outer pericardial wrap: The United Kingdom and Ireland Implanters' registry

Dowling

Firoozi

Panoulas

et al. 2019

Cathet Cardio Intervent

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“…However, this did not appear to confer a mortality difference related to PPM. A more recent 1168 patient analysis specific to ViV confirmed the association of severe preprocedural PPM and elevated mean gradients 19. All patients with severe PPM had previously received stented surgical valves.…”

Section: Introductionmentioning

confidence: 87%

“…This paper also identified an independent increase in 1-year mortality in a regression controlled for label size, STS score, renal failure, diabetes and type of surgical valve (stentless vs stented) (figure 3). 19 There are several potential explanations for this mortality effect. One hypothesis is that the exposure to many years (ie, time to failure of the surgical valve) of PPM led to irreversible changes in cardiac physiology (eg, remodelling), which precipitated ventricular dysfunction and earlier death.…”

Section: Introductionmentioning

confidence: 99%

Transcatheter aortic valve replacement in failed surgical valves

Simonato

Dvir

2019

Heart

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Aortic valve-in-valve is a less invasive alternative to surgical redo in the treatment of failed bioprosthetic valves. While only inoperable patients underwent the procedure before, operators currently offer it to those at lower risk and worldwide experience is in the thousands. Early mortality has diminished in recent analyses and improvements in symptoms and quality of life have been documented. Main considerations with aortic valve-in-valve include elevated postprocedural gradients, coronary obstruction and leaflet thrombosis. Risk factors for each of these adverse events have been described at length. Aortic valve-in-valve offers a safe and effective option in the management of failed bioprosthetic valves.

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“…However, high residual gradients (mean aortic gradient ≥20 mm Hg) are frequently observed after ViV procedure. In previous registries,3–7 small surgical valve label size (≤21 mm), stenotic pattern of BP degeneration and pre-existing prosthesis–patient mismatch (PPM) of the BP were associated with the persistence of high residual gradient, less improvement in functional capacity and increased risk of mortality following ViV. However, there are relatively few data on the degree of valve haemodynamic improvement following ViV and on how this procedure eventually restores the valve haemodynamic function to that observed early after initial SAVR.…”

Section: Introductionmentioning

confidence: 99%

Haemodynamic outcomes following aortic valve-in-valve procedure

et al. 2018

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Background and objectivesTranscatheter aortic valve-in-valve implantation (ViV) has emerged as a valuable technique to treat failed surgical bioprostheses (BPs) in patients with high risk for redo surgical aortic valve replacement (SAVR). Small BP size (≤21 mm), stenotic pattern of degeneration and pre-existing prosthesis–patient mismatch (PPM) have been associated with worse clinical outcomes after ViV. However, no study has evaluated the actual haemodynamic benefit associated with ViV. This study aims to compare haemodynamic status observed at post-ViV, pre-ViV and early after initial SAVR and to determine the factors associated with worse haemodynamic outcomes following ViV, including the rates of high residual gradient and ‘haemodynamic futility’.MethodsEarly post-SAVR, pre-ViV and post-ViV echocardiographic data of 79 consecutive patients who underwent aortic ViV at our institution were retrospectively analysed. The primary study endpoint was suboptimal valve haemodynamics (SVH) following ViV defined by the Valve Academic Research Consortium 2 as the presence of high residual aortic mean gradient (≥20 mm Hg) and/or at least moderate aortic regurgitation (AR). Haemodynamic futility of ViV was defined as <10 mm Hg decrease in mean aortic gradient and no improvement in AR compared with pre-ViV.ResultsSVH was found in 61% of patients (57% high residual gradient, 4% moderate AR) after ViV versus 24% early after SAVR. Pre-existing PPM and BP mode of failure by stenosis were independently associated with the primary endpoint (OR: 2.87; 95% CI 1.08 to 7.65; p=0.035 and OR: 3.02; 95% CI 1.08 to 8.42; p=0.035, respectively) and with the presence of high residual gradient (OR: 4.38; 95% CI 1.55 to 12.37; p=0.005 and OR: 5.37; 95% CI 1.77 to 16.30; p=0.003, respectively) following ViV. Criteria of ViV haemodynamic futility were met in 7.6% overall and more frequently in patients with pre-existing PPM and stenotic BP (18.5%) compared with other patients (2.0%). ViV restored haemodynamic function to early post-SAVR level in only 34% of patients.ConclusionAlthough ViV was associated with significant haemodynamic improvement compared with pre-ViV in >90% of patients, more than half harboured SVH outcome. Furthermore, only one-third of patients had a restoration of valve haemodynamic function to the early post-SAVR level. Pre-existing PPM and stenosis pattern of BP degeneration were the main factors associated with SVH and haemodynamic futility following ViV. These findings provide strong support for the prevention of PPM at the time of initial SAVR and careful preprocedural patient screening.

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Impact of Pre-Existing Prosthesis-Patient Mismatch on Survival Following Aortic Valve-in-Valve Procedures

Abstract: Pre-existing PPM of the failed surgical valve is strongly and independently associated with increased risk for mortality following ViV implantation.

Cited by 91 publications

References 26 publications

Initial experience of a self‐expanding transcatheter aortic valve with an outer pericardial wrap: The United Kingdom and Ireland Implanters' registry

Initial experience of a self‐expanding transcatheter aortic valve with an outer pericardial wrap: The United Kingdom and Ireland Implanters' registry

Transcatheter aortic valve replacement in failed surgical valves

Haemodynamic outcomes following aortic valve-in-valve procedure

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