Bioprosthetic valve fracture: Technical insights from a multicenter study.
Bioprosthetic valve fracture: Technical insights from a multicenter study.
- 2019
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.
English
0022-5223
10.1016/j.jtcvs.2019.01.073 [doi] S0022-5223(19)30287-9 [pii]
*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 States
MedStar Heart & Vascular Institute
Journal Article
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.
English
0022-5223
10.1016/j.jtcvs.2019.01.073 [doi] S0022-5223(19)30287-9 [pii]
*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 States
MedStar Heart & Vascular Institute
Journal Article