Valve‐in‐valve transcatheter aortic valve implantation with CoreValve/Evolut R<sup>©</sup> for degenerated small versus bigger bioprostheses

Scholtz, Smita; Piper, Cornelia; Horstkotte, Dieter; Gummert, Jan; Ensminger, Stephan; Börgermann, Jochen; Scholtz, Werner

doi:10.1111/joic.12498

Cited by 14 publications

(9 citation statements)

References 22 publications

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“…Within our sample, 49% of patients whose bioprosthesis had an internal diameter ≤19 mm had postprocedural transvalvular gradients >20 mmHg (and therefore hemodynamic failure, according to VARC-2 15 ), compared with only 23% of those with larger bioprostheses. Small surgical valves being associated with worse hemodynamic outcomes is well known (3,6,23,24). The notable result from our cohort is that rates of hemodynamic failure approached 50%, significantly higher than what has been previously described.…”

Section: Small Internal Diameterscontrasting

confidence: 44%

Hemodynamic outcomes after valve-in-valve transcatheter aortic valve replacement: a single-center experience

Kherallah

Koneru²,

Krajcer³

et al. 2021

Ann Cardiothorac Surg

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Background: Valve-in-valve transcatheter aortic valve replacement (ViV-TAVR) has emerged as a safe, effective alternative to redo aortic valve surgery in high-risk patients with degenerated surgical bioprosthetic valves. However, ViV-TAVR has been associated high postprocedural valvular gradients, compared with TAVR for native-valve aortic stenosis.Methods: We performed a retrospective study of all patients who underwent ViV-TAVR for a degenerated aortic valve bioprosthesis between January 1, 2013 and March 31, 2019 at our center. The primary outcome was postprocedural mean aortic valve gradient. Outcomes were compared across surgical valve type (stented versus stentless), surgical valve internal diameter (≤19 versus >19 mm), and transcatheter aortic valve type (self-expanding vs. balloon-expandable).Results: Overall, 89 patients underwent ViV-TAVR. Mean age was 69.0±12.6 years, 61% were male, and median Society of Thoracic Surgeons Predicted Risk of Mortality score was 5.4 [interquartile range, 3.2-8.5].Bioprosthesis mode of failure was stenotic (58% of patients), regurgitant (24%), or mixed (18%). The surgical valve was stented in 75% of patients and stentless in 25%. The surgical valve's internal diameter was ≤19 mm in 45% of cases. A balloon-expandable transcatheter valve was used in 53% of procedures. Baseline aortic valve area and mean gradients were 0.87±0.31 cm 2 and 36±18 mmHg, respectively. These improved after ViV-TAVR to 1.38±0.55 cm 2 and 18±11 mmHg at a median outpatient follow-up of 331 days.Higher postprocedural mean gradients were associated with surgical valves having an internal diameter ≤19 mm (24±13 versus 16±8, P=0.002) and with stented surgical valves (22±11 versus 12±6, P<0.001). Conclusions: ViV-TAVR is an effective option for treating degenerated surgical aortic bioprostheses, with acceptable hemodynamic outcomes. Small surgical valves and stented surgical valves are associated with higher postprocedural gradients.

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Section: Small Internal Diameterscontrasting

confidence: 44%

Hemodynamic outcomes after valve-in-valve transcatheter aortic valve replacement: a single-center experience

Kherallah

Koneru²,

Krajcer³

et al. 2021

Ann Cardiothorac Surg

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“…39 Besides, modern percutaneous valve-in-valve technologies provide less-invasive alternatives to treat potential BHV degeneration. 40 We are convinced that TAVI will supersede surgical valve implantation in the future. Based on our data and data produced by others, currently utilized a-Gal-bearing biological scaffolds must be optimized by the commercial medical device industry.…”

Section: Discussionmentioning

confidence: 97%

“… 39 Besides, modern percutaneous valve-in-valve technologies provide less-invasive alternatives to treat potential BHV degeneration. 40 …”

Section: Discussionmentioning

confidence: 99%

Inflammatory immune response in recipients of transcatheter aortic valves

et al. 2021

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Objective: Transcatheter aortic valve implantation (TAVI) is rapidly replacing cardiac surgery due to its minimal invasiveness and practicality. Midterm immunological studies on the biocompatibility of galactose-alpha-1,3-galactose (a-Gal)carrying bioprosthetic heart valves for TAVI are not available. In this study we investigated whether bioprosthetic heart valves employed for TAVI augment an a-Gal-specific antibody-dependent and antibody-independent immune response 3 months after TAVI implantation. PERSPECTIVENext-generation transcatheter aortic valve implantation, deficient for Gal, will show whether immune activity can be dampened with the potential consequence of increased valve durability.See Commentaries on pages 97 and 99.

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“…Scholz et al [ 20 ] focused their study on results after self-expandable TAVI-ViV depending on degenerated valve size. Small valves (< 23 mm) were associated with significant higher postoperative gradient than bigger valves (22.8 ± 9.4 mmHg vs .…”

Section: Discussionmentioning

confidence: 99%

High Residual Gradient Following a SelfExpandable Transcatheter Aortic Valve-in-Valve Implantation — Risk Factor Analysis, Outcomes, and Survival

Stankowski

Aboul-Hassan

Stępiński

et al. 2022

Braz J Cardiovasc Surg

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Introduction Transcatheter aortic valve-in-valve implantation (TAVI-ViV) can be associated with unfavorable hemodynamic outcomes. This study aimed to estimate the prevalence, identify the risk factors, and evaluate the outcomes and survival of patients with high residual gradients after TAVI-ViV. Methods A total of 85 patients were included in the study. The cohort was divided into group A, with postprocedural mean pressure gradient (PG) ≥ 20 mmHg, and group B, with mean PG < 20 mmHg. Results Postprocedural PG ≥ 20 mmHg was observed in 24.7% of the patients. In a univariate analysis, preoperative gradient, pre-existing patient-prosthesis mismatch (PPM), deep valve implantation, small degenerated valves, and an older generation of transcatheter aortic valves were found to be risk factors for high residual gradient. Multivariate analysis showed that preexisting maxPG > 60 mmHg, implantation level of 4 mm below neo-annulus, and degenerated valve size ≤ 23 mm were independent predictors of high residual gradient. There were no differences in early morbidity (myocardial infarction, pacemaker implantation, stroke, acute renal insufficiency) between groups. Kaplan-Meier estimated that the survival rate was comparable at one and five years regardless of postoperative gradient. Survivors with high residual mean gradient were significantly affected by a high New York Heart Association (NYHA) class. Conclusion High residual transvalvular gradient after TAVI-ViV is not rare, but it does not significantly affect mortality. High residual mean gradient has a negative impact on NYHA functional class improvement after the procedure. High preoperative gradient, implantation level, and small failed bioprosthesis may predispose to increased residual gradient.

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Valve‐in‐valve transcatheter aortic valve implantation with CoreValve/Evolut R^© for degenerated small versus bigger bioprostheses

Abstract: ViV-TAVI with CoreValve/R is demonstrated to be safe and effective in terms of no coronary obstruction and very low mortality up to 3 years despite slightly higher mean transprosthetic gradients especially in very small bioprostheses.

Cited by 14 publications

References 22 publications

Hemodynamic outcomes after valve-in-valve transcatheter aortic valve replacement: a single-center experience

Hemodynamic outcomes after valve-in-valve transcatheter aortic valve replacement: a single-center experience

Inflammatory immune response in recipients of transcatheter aortic valves

High Residual Gradient Following a SelfExpandable Transcatheter Aortic Valve-in-Valve Implantation — Risk Factor Analysis, Outcomes, and Survival

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Valve‐in‐valve transcatheter aortic valve implantation with CoreValve/Evolut R© for degenerated small versus bigger bioprostheses

Abstract: ViV-TAVI with CoreValve/R is demonstrated to be safe and effective in terms of no coronary obstruction and very low mortality up to 3 years despite slightly higher mean transprosthetic gradients especially in very small bioprostheses.

Cited by 14 publications

References 22 publications

Hemodynamic outcomes after valve-in-valve transcatheter aortic valve replacement: a single-center experience

Hemodynamic outcomes after valve-in-valve transcatheter aortic valve replacement: a single-center experience

Inflammatory immune response in recipients of transcatheter aortic valves

High Residual Gradient Following a SelfExpandable Transcatheter Aortic Valve-in-Valve Implantation — Risk Factor Analysis, Outcomes, and Survival

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Valve‐in‐valve transcatheter aortic valve implantation with CoreValve/Evolut R^© for degenerated small versus bigger bioprostheses