Fracturing the Ring of Small Mitroflow Bioprostheses by High-Pressure Balloon Predilatation in Transcatheter Aortic Valve-in-Valve Implantation

Nielsen‐Kudsk, Jens Erik; Christiansen, Evald Høj; Terkelsen, Christian Juhl; Nørgaard, Bjarne Linde; Jensen, Kimmo; Krusell, Lars Romer; Tang, Mariann; Terp, Kim; Klaaborg, Kaj-Erik; Andersen, Henning

doi:10.1161/circinterventions.115.002667

Cited by 54 publications

(44 citation statements)

References 4 publications

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“…16 Several operators have attempted aggressive dilatation with some degree of success by breaking the surgical valve ring with a high-pressure balloon. 24 BMI indicates body mass index; BSA, body surface area; IQR, interquartile range; LVEF, left ventricular ejection fraction; NYHA, New York Heart Association; PPM, prosthesis-patient mismatch; STS, Society of Thoracic Surgeons; and THV, transcatheter heart valve.…”

Section: Postprocedural Gradientsmentioning

confidence: 99%

Transcatheter Replacement of Failed Bioprosthetic Valves

Simonato

Webb

Kornowski

et al. 2016

Circ: Cardiovascular Interventions

113

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Background-Transcatheter valve implantation inside failed bioprosthetic surgical valves (valve-in-valve [ViV]) may offer an advantage over reoperation. Supra-annular transcatheter valve position may be advantageous in achieving better hemodynamics after ViV. Our objective was to define targets for implantation that would improve hemodynamics after ViV. Methods and Results-Cases from the Valve-in-Valve International Data (VIVID) registry were analyzed using centralized core laboratory assessment blinded to clinical events. Multivariate analysis was performed to identify independent predictors of elevated postprocedural gradients (mean ≥20 mm Hg). Optimal implantation depths were defined by receiver operating characteristic curve. A total of 292 consecutive patients (age, 78.9±8.7 years; 60.3% male; 157 CoreValve Evolut and 135 Sapien XT) were evaluated. High implantation was associated with significantly lower rates of elevated gradients in comparison with low implantation (CoreValve Evolut, 15% versus 34.2%; P=0.03 and Sapien XT, 18.5% versus 43.5%; P=0.03, respectively). Optimal implantation depths were defined: CoreValve Evolut, 0 to 5 mm; Sapien XT, 0 to 2 mm (0-10% frame height); sensitivities, 91.3% and 88.5%, respectively. The strongest independent correlate for elevated gradients after ViV was device position (high: odds ratio, 0.22; confidence interval, 0.1-0.52; P=0.001), in addition to type of device used (CoreValve Evolut: odds ratio, 0.5; confidence interval, 0.28-0.88; P=0.02) and surgical valve mechanism of failure (stenosis/mixed baseline failure: odds ratio, 3.12; confidence interval, 1.51-6.45; P=0.002). Conclusions-High implantation inside failed bioprosthetic valves is a strong independent correlate of lower postprocedural gradients in both self-and balloon-expandable transcatheter valves. These clinical evaluations support specific implantation targets to optimize hemodynamics after ViV. (Circ Cardiovasc Interv. 2016;9:e003651.

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Section: Postprocedural Gradientsmentioning

confidence: 99%

Transcatheter Replacement of Failed Bioprosthetic Valves

Simonato

Webb

Kornowski

et al. 2016

Circ: Cardiovascular Interventions

113

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“…Within days his LV function improved from ∼10 to 15% to ∼40% (Supporting Information Movie 3). While post‐deployment balloon dilation “cracking” of the surgical prosthesis ring has been described , we have found that even without obviously cracking the prosthetic valve ring, the valve‐in‐valve post‐dilation provides improved hemodynamics as measured invasively and by echocardiography, likely as a result of increased “stretch” on the surgical prosthetic annulus.…”

Section: Discussionmentioning

confidence: 69%

Emergency valve‐in‐valve transcatheter aortic valve replacement in a patient with degenerated bioprosthetic aortic stenosis and cardiogenic shock on veno‐arterial extracorporeal membrane oxygenation

Summers

Mick

Kapadia

et al. 2017

Cathet Cardio Intervent

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The use of transcatheter aortic valve replacement (TAVR) as an acute treatment in severe decompensated bioprosthetic aortic valve disease is not well documented. We describe herein a unique case in which valve-in-valve (ViV) TAVR was successfully used as both an emergency salvage therapy and a bridge to definitive fourth reoperative aortic valve replacement (AVR) in a young patient with cardiogenic shock secondary to bioprosthetic aortic valve stenosis who was dependent on veno-arterial extracorporeal membrane oxygenation (VA-ECMO). © 2017 Wiley Periodicals, Inc.

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“…Post‐dilation likely improves hemodynamics by stretching and in some cases cracking the valve frame, providing a larger stent frame diameter and effective orifice area (Table ). Valve ring fracture has previously been described with aggressive pre‐dilation of the surgical valve before ViV . We, however, prefer to avoid pre‐dilation as this could result in significant hemodynamic perturbations or cerebral embolism of valve debris.…”

Section: Discussionmentioning

confidence: 99%

“…ViV [11]. We, however, prefer to avoid pre-dilation as this could result in significant hemodynamic perturbations or cerebral embolism of valve debris.…”

Section: R E Su Ltsmentioning

confidence: 99%