Bioprosthetic valve fracture: Technical insights from a multicenter study.

MedStar author(s):
Citation: Journal of Thoracic & Cardiovascular Surgery. 158(5):1317-1328.e1, 2019 Nov.PMID: 30857820Institution: MedStar Heart & Vascular InstituteForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *Aortic Valve Stenosis | *Aortic Valve/su [Surgery] | *Balloon Valvuloplasty/mt [Methods] | *Bioprosthesis | *Heart Valve Prosthesis | *Reoperation | *Transcatheter Aortic Valve Replacement | Aged | Aged, 80 and over | Aortic Valve Stenosis/ep [Epidemiology] | Aortic Valve Stenosis/pp [Physiopathology] | Aortic Valve Stenosis/su [Surgery] | Aortic Valve/dg [Diagnostic Imaging] | Aortic Valve/pa [Pathology] | Bioprosthesis/ae [Adverse Effects] | Bioprosthesis/sn [Statistics & Numerical Data] | Female | Heart Valve Prosthesis/ae [Adverse Effects] | Heart Valve Prosthesis/sn [Statistics & Numerical Data] | Hemodynamics | Humans | Male | Outcome and Process Assessment, Health Care | Prosthesis Design | Prosthesis Failure | Reoperation/is [Instrumentation] | Reoperation/mt [Methods] | Transcatheter Aortic Valve Replacement/ae [Adverse Effects] | Transcatheter Aortic Valve Replacement/is [Instrumentation] | Transcatheter Aortic Valve Replacement/mt [Methods] | United StatesYear: 2019Local holdings: Available online from MWHC library: 1994 - present, Available in print through MWHC library: 1999 - 2006ISSN:
  • 0022-5223
Name of journal: The Journal of thoracic and cardiovascular surgeryAbstract: CONCLUSIONS: BVF can be performed safely and results in reduced residual transvalvular gradients. Performing BVF after VIV TAVR and using larger balloon appears to achieve the best hemodynamic results. Copyright (c) 2019 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.METHODS: BVF was performed in 75 patients at 21 centers. Hierarchical multiple linear regression was performed to identify variables that were associated with lower final transvalvular gradient.OBJECTIVE: Valve-in-valve transcatheter aortic valve replacement (VIV TAVR) can result in high residual gradients that are associated with increased mortality. Bioprosthetic valve fracture (BVF) has been shown to improve residual gradients following VIV TAVR; however, factors influencing the results of BVF have not been studied.RESULTS: Surgical valves with a median true internal diameter of 18.5 mm (interquartile range, 17.0-20.5 mm) were treated with VIV TAVR in conjunction with BVF using balloon-expandable (n = 43) or self-expanding (n = 32) transcatheter heart valves with a median size of 23 mm (interquartile range, 23-23 mm). There were no aortic root disruptions, coronary occlusions, or new pacemakers; in-hospital or 30-day mortality was 2.6% (2 out of 75). Final mean transvalvular gradient was 9.2 +/- 6.3 mm Hg, but was significantly lower when BVF was performed after VIV TAVR compared with BVF first (8.1 +/- 4.8 mm Hg vs 16.9 +/- 10.1 mm Hg; P < .001). After adjusting for timing of BVF (ie, before or after VIV TAVR), transcatheter heart valve size/type, surgical valve mode of failure, true internal diameter, and baseline gradient and BVF balloon size, performing BVF after VIV TAVR (P < .001) and using a larger BVF balloon (P = .038) were the only independent predictors of lower final mean gradient.All authors: Allen KB, Bavry AA, Bioprosthetic Valve Fracture Investigators, Chhatriwalla AK, Cohen DJ, Dvir D, Kennedy KF, Lee R, Loyalka P, Nguyen TC, Rovin JD, Saxon JT, Thourani V, Webb J, Whisenant BFiscal year: FY2020Digital Object Identifier: Date added to catalog: 2019-11-05
Holdings
Item type Current library Collection Call number Status Date due Barcode
Journal Article MedStar Authors Catalog Article 30857820 Available 30857820

Available online from MWHC library: 1994 - present, Available in print through MWHC library: 1999 - 2006

CONCLUSIONS: BVF can be performed safely and results in reduced residual transvalvular gradients. Performing BVF after VIV TAVR and using larger balloon appears to achieve the best hemodynamic results. Copyright (c) 2019 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

METHODS: BVF was performed in 75 patients at 21 centers. Hierarchical multiple linear regression was performed to identify variables that were associated with lower final transvalvular gradient.

OBJECTIVE: Valve-in-valve transcatheter aortic valve replacement (VIV TAVR) can result in high residual gradients that are associated with increased mortality. Bioprosthetic valve fracture (BVF) has been shown to improve residual gradients following VIV TAVR; however, factors influencing the results of BVF have not been studied.

RESULTS: Surgical valves with a median true internal diameter of 18.5 mm (interquartile range, 17.0-20.5 mm) were treated with VIV TAVR in conjunction with BVF using balloon-expandable (n = 43) or self-expanding (n = 32) transcatheter heart valves with a median size of 23 mm (interquartile range, 23-23 mm). There were no aortic root disruptions, coronary occlusions, or new pacemakers; in-hospital or 30-day mortality was 2.6% (2 out of 75). Final mean transvalvular gradient was 9.2 +/- 6.3 mm Hg, but was significantly lower when BVF was performed after VIV TAVR compared with BVF first (8.1 +/- 4.8 mm Hg vs 16.9 +/- 10.1 mm Hg; P < .001). After adjusting for timing of BVF (ie, before or after VIV TAVR), transcatheter heart valve size/type, surgical valve mode of failure, true internal diameter, and baseline gradient and BVF balloon size, performing BVF after VIV TAVR (P < .001) and using a larger BVF balloon (P = .038) were the only independent predictors of lower final mean gradient.

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