Clin Res Cardiol (2023). https://doi.org/10.1007/s00392-023-02180-w
Long-term Outcome of Bioprosthetic Valve Fracture in Transcatheter Aortic Valve-in-Valve Procedures
C. Brinkmann1, A. Scotti2, A. Latib2, M. Abdel-Wahab3, J. Stripling4, D. Hildick-Smith5, C. Pavitt5, O. Bhadra6, L. Conradi6, A. Eitan7, J. Schofer1
1Prof. Mathey, Prof. Schofer GmbH, Medizinisches Versorgungszentrum, Hamburg; 2Interventional Cardiology, Montefiore Medical Center, New York, US; 3Klinik für Innere Medizin/Kardiologie, Herzzentrum Leipzig - Universität Leipzig, Leipzig; 4Albertinen Krankenhaus, Herz- und Gefäßzentrum, Hamburg; 5Sussex Cardiac Centre, Royal Sussex County Hospital, Brighton, UK; 6Klinik und Poliklinik für Herz- und Gefäßchirurgie, Universitäres Herz- und Gefäßzentrum Hamburg, Hamburg; 7Carmel Medical Center, Haifa, IL;

Background

Valve in Valve transcatheter aortic valve implantation (VIV-TAVI) in small surgical valves (true inner diameter, ID) < 23 mm) results in residual gradients ≥ 20 mmHg in 20 to 40 % of the patients, which impacts patient outcome. Bioprosthetic valve fracture (BVF) has been shown to safely reduce residual gradients during VIV-TAVI. Whether this reduction is durable and BVF does not impact transcatheter heart valve (THV) longevity has not yet been evaluated and is the aim of this study.

 

Methods

Data of 50 pts with degenerated aortic bioprostheses who underwent BVF in conjunction with VIV-TAVI were collected from 7 international centers. BVF was performed with a non-compliant (NC) balloon sized 1-4mm larger than bioprosthesis ID. Data were collected at discharge/30days, at intermediate and late follow-up.

 

Results

Mean age was 77.8 ± 9 years, 35% male, STS prom score 4.5 ± 2.7%, log. Euroscore I 21,4 ± 12,8% (mean ± SD). BVF was performed in 6 types of surgical bioprostheses (Sorin Mitroflow 26%, Medtronic Mosaic 18%, Edwards Magna 18%, Edwards Perimount 22%, St. Jude Epic 10%, Edwards CE Standard 6%), true ID was 18.9 ± 2.1mm, mean interval to valve failure was 11.5 ± 3.8 years. Degeneration mode was stenosis or mixed in 92.5%. THVs for VIV-TAVI were balloon-expandable in 20% and self-expanding in 80%. BVF was performed either prior (15%) or after THV implantation (85%). NC-balloons were oversized by 2.5 ± 0.8mm in relation to the true ID. Mean transvalvular gradient (MVG) was reduced by VIV-TAVI in conjunction with BVF from 42.3 ± 29.0 mmHg to 12.45 ± 6.8 mmHg at discharge/30days (p<0.01).  Compared to discharge MVG did not change after 201 ± 164 days (intermediate follow-up, MVG 11.9 ± 6.2 mmHg) as well as after 822 ± 359 days (late follow-up, MVG 13±5.6mmHg, p < 0.01). VARC-2-defined periprocedural and 30-day-complication rate was 0%, at late follow-up 5 patients had died of a non-valve related cause and 1 was re-hospitalized for non-valve related heart failure. No stroke, no THV dysfunction and no re-intervention was observed.

 

Conclusion

The significant reduction of MVG, which can be safely achieved by BVF in VIV-TAVI, remains stable up to 4 years post procedure with no signs of THV dysfunction.
https://dgk.org/kongress_programme/jt2023/aP2078.html