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

Research output: Contribution to journalArticlepeer-review

10 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 languageEnglish (US)
Pages (from-to)848-855
Number of pages8
JournalEuroIntervention
Volume17
Issue number10
DOIs
StatePublished - Nov 2021

Keywords

  • Aortic stenosis
  • Degenerative valve
  • TAVI
  • Valve-in-valve

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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