Leaflet stress and strain distributions following incomplete transcatheter aortic valve expansion

Abbasi, Moslem; Azadani, Ali N.

doi:10.1016/j.jbiomech.2015.08.012

Cited by 89 publications

(73 citation statements)

References 39 publications

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“…An inadequately expanded THV may be at risk of elevated transvalvular gradient because of inadequate leaflet expansion and mobility, also potentially increasing the risk of accelerated leaflet degeneration 1, 2, 4, 11…”

Section: Appropriate Valve Expansionmentioning

confidence: 99%

“…Registry and in vitro data suggest that supra‐annular THVs are associated with lower gradients after aortic VIV procedures; however, technical factors, such as future access to the coronary vessels, concerns about THV recoil associated with self‐expanding devices, or use of deliberate bioprosthetic ring fracture, may prompt selection of a balloon‐expandable intra‐annular THV 11, 16, 29, 30, 31, 32. While randomized comparisons of the transvalvular gradient after S3 versus supra‐annular THV implantation in surgical bioprostheses have not been performed, accurate sizing, positioning, and deployment of the S3 is clearly essential in order to achieve a good functional outcome with low transvalvular gradients.…”

Section: Balloon‐inflatable Versus Self‐expanding Thvs In Viv Proceduresmentioning

confidence: 99%

See 1 more Smart Citation

Transcatheter Aortic and Mitral Valve‐in‐Valve Implantation Using the Edwards Sapien 3 Heart Valve

Shivaraju

Michel

Frangieh

et al. 2018

JAHA

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Section: Appropriate Valve Expansionmentioning

confidence: 99%

Section: Balloon‐inflatable Versus Self‐expanding Thvs In Viv Proceduresmentioning

confidence: 99%

Transcatheter Aortic and Mitral Valve‐in‐Valve Implantation Using the Edwards Sapien 3 Heart Valve

Shivaraju

Michel

Frangieh

et al. 2018

JAHA

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“…18 An in vitro study also indicated that incomplete expansion of the THV induces mechanical stress in the leaflets, which may lead to premature SVD. 19 This is a very important concern when considering VIV TAVR for a younger and lower-risk population.…”

Section: Hemodynamic and Procedural Outcomesmentioning

confidence: 99%

Outcomes of Self-Expanding vs. Balloon-Expandable Transcatheter Heart Valves for the Treatment of Degenerated Aortic Surgical Bioprostheses　― A Propensity Score-Matched Comparison ―

Ochiai

Yoon

Sharma

et al. 2018

Circ J

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Background:Transcatheter aortic valve-in-valve (VIV) replacement within failed bioprosthetic surgical aortic valves is a feasible therapeutic option. However, data comparing the hemodynamic and clinical outcomes of VIV replacement with supra-annular self-expanding and balloon-expandable transcatheter heart valves (THV) are limited. Methods and Results:Outcomes of 40 and 95 patients treated with supra-annular self-expanding and balloon-expandable THV, respectively, were compared after propensity score matching, which yielded 37 pairs of patients with similar baseline characteristics. Hemodynamic and clinical outcomes were analyzed. Postprocedural mean gradient was significantly lower in the self-expanding THV group than in the balloon-expandable THV group (12.1±6.1 mmHg vs. 19.0±7.3 mmHg, P<0.001). The incidence of at least mild postprocedural aortic regurgitation (AR) was comparable between the self-expanding and balloon-expandable THV groups (21.6% vs. 10.8%, P=0.39). In the self-expanding THV group, the new-generation THV showed a trend towards a lower incidence of at least mild AR compared with the early-generation THV (12.5% vs. 38.5%, P=0.07). A similar trend was observed in the balloon-expandable THV group (4.2% vs. 23.1%, P=0.08). There was no significant difference between the self-expanding and balloon-expandable THV groups in the cumulative 2-year all-cause mortality rates (22.4% vs. 43.4%, log-rank P=0.26). Conclusions:The supra-annular self-expanding THV was associated with a lower postprocedural mean gradient compared with balloon-expandable THV in patients undergoing aortic VIV replacement.

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“…10,11 Suboptimal THV leaflet coaptation, leaflet-frame contact, and poor hemodynamics after ViV implantation could impair device durability, which is a concern especially in patients with reasonable life expectancy. 12 Therefore, it is widely agreed that operators of ViV procedures should aim for lower gradients. Supra-annular THV device position may be advantageous in achieving better leaflet function and hemodynamics after ViV.…”

mentioning

confidence: 99%

Transcatheter Replacement of Failed Bioprosthetic Valves

Simonato

Webb

Kornowski

et al. 2016

Circ: Cardiovascular Interventions

112

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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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Leaflet stress and strain distributions following incomplete transcatheter aortic valve expansion

Cited by 89 publications

References 39 publications

Transcatheter Aortic and Mitral Valve‐in‐Valve Implantation Using the Edwards Sapien 3 Heart Valve

Transcatheter Aortic and Mitral Valve‐in‐Valve Implantation Using the Edwards Sapien 3 Heart Valve

Outcomes of Self-Expanding vs. Balloon-Expandable Transcatheter Heart Valves for the Treatment of Degenerated Aortic Surgical Bioprostheses　― A Propensity Score-Matched Comparison ―

Transcatheter Replacement of Failed Bioprosthetic Valves

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Leaflet stress and strain distributions following incomplete transcatheter aortic valve expansion

Cited by 89 publications

References 39 publications

Transcatheter Aortic and Mitral Valve‐in‐Valve Implantation Using the Edwards Sapien 3 Heart Valve

Transcatheter Aortic and Mitral Valve‐in‐Valve Implantation Using the Edwards Sapien 3 Heart Valve

Outcomes of Self-Expanding vs. Balloon-Expandable Transcatheter Heart Valves for the Treatment of Degenerated Aortic Surgical Bioprostheses ― A Propensity Score-Matched Comparison ―

Transcatheter Replacement of Failed Bioprosthetic Valves

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Outcomes of Self-Expanding vs. Balloon-Expandable Transcatheter Heart Valves for the Treatment of Degenerated Aortic Surgical Bioprostheses　― A Propensity Score-Matched Comparison ―