Outcomes of valve-in-valve transcatheter aortic valve implantation with and without bioprosthetic valve fracture

Christina Brinkmann; Mohamed Abdel-Wahab; Francesco Bedogni; Oliver D. Bhadra; Gaetan Charbonnier; Lenard Conradi; David Hildick-Smith; Faraj Kargoli; Azeem Latib; Nicolas M. Van Mieghem; Darren Mylotte; Uri Landes; Thomas Pilgrim; Jan Stripling; Maurizio Taramasso; Didier Tchétché; Luca Testa; Holger Thiele; John Webb; Stephan Windecker; Julian Witt; Peter Wohlmuth; Joachim Schofer

doi:10.4244/EIJ-D-21-00254

Outcomes of valve-in-valve transcatheter aortic valve implantation with and without bioprosthetic valve fracture

Christina Brinkmann, Mohamed Abdel-Wahab, Francesco Bedogni, Oliver D. Bhadra, Gaetan Charbonnier, Lenard Conradi, David Hildick-Smith, Faraj Kargoli, Azeem Latib, Nicolas M. Van Mieghem, Darren Mylotte, Uri Landes, Thomas Pilgrim, Jan Stripling, Maurizio Taramasso, Didier Tchétché, Luca Testa, Holger Thiele, John Webb, Stephan WindeckerJulian Witt, Peter Wohlmuth, Joachim Schofer

Medicine

Research output: Contribution to journal › Article › peer-review

15 Scopus citations

Abstract

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 selfexpanding 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.

Original language	English (US)
Pages (from-to)	848-855
Number of pages	8
Journal	EuroIntervention
Volume	17
Issue number	10
DOIs	https://doi.org/10.4244/EIJ-D-21-00254
State	Published - Nov 2021

Keywords

Aortic stenosis
Degenerative valve
TAVI
Valve-in-valve

ASJC Scopus subject areas

Cardiology and Cardiovascular Medicine

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10.4244/EIJ-D-21-00254

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Brinkmann, C., Abdel-Wahab, M., Bedogni, F., Bhadra, O. D., Charbonnier, G., Conradi, L., Hildick-Smith, D., Kargoli, F., Latib, A., Van Mieghem, N. M., Mylotte, D., Landes, U., Pilgrim, T., Stripling, J., Taramasso, M., Tchétché, D., Testa, L., Thiele, H., Webb, J., ... Schofer, J. (2021). Outcomes of valve-in-valve transcatheter aortic valve implantation with and without bioprosthetic valve fracture. EuroIntervention, 17(10), 848-855. https://doi.org/10.4244/EIJ-D-21-00254

Brinkmann, C, Abdel-Wahab, M, Bedogni, F, Bhadra, OD, Charbonnier, G, Conradi, L, Hildick-Smith, D, Kargoli, F, Latib, A, Van Mieghem, NM, Mylotte, D, Landes, U, Pilgrim, T, Stripling, J, Taramasso, M, Tchétché, D, Testa, L, Thiele, H, Webb, J, Windecker, S, Witt, J, Wohlmuth, P & Schofer, J 2021, 'Outcomes of valve-in-valve transcatheter aortic valve implantation with and without bioprosthetic valve fracture', EuroIntervention, vol. 17, no. 10, pp. 848-855. https://doi.org/10.4244/EIJ-D-21-00254

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title = "Outcomes of valve-in-valve transcatheter aortic valve implantation with and without bioprosthetic valve fracture",

abstract = "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 selfexpanding 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.",

keywords = "Aortic stenosis, Degenerative valve, TAVI, Valve-in-valve",

author = "Christina Brinkmann and Mohamed Abdel-Wahab and Francesco Bedogni and Bhadra, {Oliver D.} and Gaetan Charbonnier and Lenard Conradi and David Hildick-Smith and Faraj Kargoli and Azeem Latib and {Van Mieghem}, {Nicolas M.} and Darren Mylotte and Uri Landes and Thomas Pilgrim and Jan Stripling and Maurizio Taramasso and Didier Tch{\'e}tch{\'e} and Luca Testa and Holger Thiele and John Webb and Stephan Windecker and Julian Witt and Peter Wohlmuth and Joachim Schofer",

note = "Publisher Copyright: {\textcopyright} Europa Digital & Publishing 2021.",

year = "2021",

month = nov,

doi = "10.4244/EIJ-D-21-00254",

language = "English (US)",

volume = "17",

pages = "848--855",

journal = "EuroIntervention",

issn = "1774-024X",

publisher = "EuroPCR",

number = "10",

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TY - JOUR

T1 - Outcomes of valve-in-valve transcatheter aortic valve implantation with and without bioprosthetic valve fracture

AU - Brinkmann, Christina

AU - Abdel-Wahab, Mohamed

AU - Bedogni, Francesco

AU - Bhadra, Oliver D.

AU - Charbonnier, Gaetan

AU - Conradi, Lenard

AU - Hildick-Smith, David

AU - Kargoli, Faraj

AU - Latib, Azeem

AU - Van Mieghem, Nicolas M.

AU - Mylotte, Darren

AU - Landes, Uri

AU - Pilgrim, Thomas

AU - Stripling, Jan

AU - Taramasso, Maurizio

AU - Tchétché, Didier

AU - Testa, Luca

AU - Thiele, Holger

AU - Webb, John

AU - Windecker, Stephan

AU - Witt, Julian

AU - Wohlmuth, Peter

AU - Schofer, Joachim

PY - 2021/11

Y1 - 2021/11

N2 - 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 selfexpanding 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.

AB - 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 selfexpanding 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.

KW - Aortic stenosis

KW - Degenerative valve

KW - TAVI

KW - Valve-in-valve

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VL - 17

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JO - EuroIntervention

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ER -

Outcomes of valve-in-valve transcatheter aortic valve implantation with and without bioprosthetic valve fracture

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