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Sathananthan J, Sellers S, Barlow AM, Stanová V, Fraser R, Toggweiler S, Allen KB, Chhatriwalla A, Murdoch DJ, Hensey M, Lau K, Alkhodair A, Dvir D, Asgar AW, Cheung A, Blanke P, Ye J, Rieu R, Pibarot P, Wood D, Leipsic J, Webb JG. Valve-in-Valve Transcatheter Aortic Valve Replacement and Bioprosthetic Valve Fracture Comparing Different Transcatheter Heart Valve Designs: An Ex Vivo Bench Study. JACC Cardiovasc Interv 2019; 12:65-75. [PMID: 30621980 DOI: 10.1016/j.jcin.2018.10.043] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 10/04/2018] [Accepted: 10/23/2018] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The authors assessed the effect of valve-in-valve (VIV) transcatheter aortic valve replacement (TAVR) followed by bioprosthetic valve fracture (BVF), testing different transcatheter heart valve (THV) designs in an ex vivo bench study. BACKGROUND Bioprosthetic valve fracture can be performed to improve residual transvalvular gradients following VIV TAVR. METHODS The authors evaluated VIV TAVR and BVF with the SAPIEN 3 (S3) (Edwards Lifesciences, Irvine, California) and ACURATE neo (Boston Scientific Corporation, Natick, Massachusetts) THVs. A 20-mm and 23-mm S3 were deployed in a 19-mm and 21-mm Mitroflow (Sorin Group USA, Arvada, Colorado), respectively. A small ACURATE neo was deployed in both sizes of Mitroflow tested. VIV TAVR samples underwent multimodality imaging, and hydrodynamic evaluation before and after BVF. RESULTS A high implantation was required to enable full expansion of the upper crown of the ACURATE neo and allow optimal leaflet function. Marked underexpansion of the lower crown of the THV within the surgical valve was also observed. Before BVF, VIV TAVR in the 19-mm Mitroflow had high transvalvular gradients using either THV design (22.0 mm Hg S3, and 19.1 mm Hg ACURATE neo). After BVF, gradients improved and were similar for both THVs (14.2 mm Hg S3, and 13.8 mm Hg ACURATE neo). The effective orifice area increased with BVF from 1.2 to 1.6 cm2 with the S3 and from 1.4 to 1.6 cm2 with the ACURATE neo. Before BVF, VIV TAVR with the ACURATE neo in the 21-mm Mitroflow had lower gradients compared with S3 (11.3 mm Hg vs. 16 mm Hg). However, after BVF valve gradients were similar for both THVs (8.4 mm Hg ACURATE neo vs. 7.8 mm Hg S3). The effective orifice area increased from 1.5 to 2.1 cm2 with the S3 and from 1.8 to 2.2 cm2 with the ACURATE neo. CONCLUSIONS BVF performed after VIV TAVR results in improved residual gradients. Following BVF, residual gradients were similar irrespective of THV design. Use of a small ACURATE neo for VIV TAVR in small (≤21 mm) surgical valves may be associated with challenges in achieving optimum THV position and expansion. BVF could be considered in selected clinical cases.
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Affiliation(s)
- Janarthanan Sathananthan
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Stephanie Sellers
- Centre for Heart Lung Innovation, Vancouver, British Columbia, Canada; Department of Radiology, St. Paul's Hospital and University of British Columbia, Vancouver, British Columbia, Canada
| | - Aaron M Barlow
- Centre for Heart Lung Innovation, Vancouver, British Columbia, Canada
| | | | - Rob Fraser
- ViVitro Labs Inc., Victoria, British Columbia, Canada
| | | | - Keith B Allen
- Saint Luke's Hospital, St. Luke's Mid America Heart Institute, Kansas City, Missouri
| | - Adnan Chhatriwalla
- Saint Luke's Hospital, St. Luke's Mid America Heart Institute, Kansas City, Missouri
| | - Dale J Murdoch
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada; University of Queensland, Brisbane, Australia
| | - Mark Hensey
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Karen Lau
- Centre for Heart Lung Innovation, Vancouver, British Columbia, Canada; Department of Radiology, St. Paul's Hospital and University of British Columbia, Vancouver, British Columbia, Canada
| | - Abdullah Alkhodair
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Danny Dvir
- University of Washington, Seattle, Washington
| | | | - Anson Cheung
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Philipp Blanke
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada; Department of Radiology, St. Paul's Hospital and University of British Columbia, Vancouver, British Columbia, Canada
| | - Jian Ye
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Régis Rieu
- Aix-Marseille Univ, IFSTTAR, LBA UMR_T24, Marseille, France
| | | | - David Wood
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jonathan Leipsic
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada; Department of Radiology, St. Paul's Hospital and University of British Columbia, Vancouver, British Columbia, Canada
| | - John G Webb
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
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Holzamer A, Kim WK, Rück A, Sathananthan J, Keller L, Cosma J, Bauer T, Nef H, Amat-Santos IJ, Brinkert M, Husser O, Pellegrini C, Schofer J, Nerla R, Montorfano M, Giannini F, Stella P, Kuwata S, Hilker M, Castriota F, Ussia GP, Webb JG, Nietlispach F, Toggweiler S. Valve-in-Valve Implantation Using the ACURATE Neo in Degenerated Aortic Bioprostheses. JACC Cardiovasc Interv 2019; 12:2309-2316. [DOI: 10.1016/j.jcin.2019.07.042] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 06/26/2019] [Accepted: 07/23/2019] [Indexed: 12/21/2022]
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