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Hemodynamic and Mid-Term Outcomes for Transcatheter Aortic Valve Replacement in Degenerated Internally Stented Valves.
Hemodynamic and Mid-Term Outcomes for Transcatheter Aortic Valve Replacement in Degenerated Internally Stented Valves.
- Source :
-
JACC. Cardiovascular interventions [JACC Cardiovasc Interv] 2023 Mar 13; Vol. 16 (5), pp. 542-554. - Publication Year :
- 2023
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Abstract
- Background: Valve-in-valve (ViV) transcatheter aortic valve replacement is indicated in patients undergoing repeat intervention for degenerative aortic valve bioprostheses. Patients with internally stented valves (ie, Mitroflow and Trifecta) are at high risk for coronary artery obstruction during ViV procedures because of valve design, as the leaflets are mounted outside the valve stent.<br />Objectives: The aim of this study was to compare the hemodynamic and clinical outcomes of transcatheter aortic valve replacement within internally stented valves (ViV-IS) vs other surgical valves (ViV-OS).<br />Methods: Baseline characteristics, hemodynamic parameters, and clinical outcomes of patients who underwent ViV-IS were retrospectively collected and compared with those of patients who underwent ViV-OS.<br />Results: A total of 250 patients (65% men, median Society of Thoracic Surgeons score 4.4% [IQR: 2.2%-8.4%]) were included. Seventy-one patients (28%) underwent ViV-IS, and 179 (72%) patients underwent ViV-OS. Patients who underwent ViV-OS had better periprocedural hemodynamic status compared with those who underwent ViV-IS (median mean gradient 6 [IQR: 2-13] vs 12 [IQR: 6-16]; P < 0.001). This was not significantly different when both groups were matched on the basis of age, sex, and valve internal diameter size (median mean gradient: 18 [IQR: 13-25] for ViV-OS vs 18 [IQR: 11-24] for ViV-IS; P = 0.36). Coronary protection for potential occlusion was performed more in ViV-IS vs ViV-OS pr (79% vs 6%, respectively; P < 0.001). Patients who underwent ViV-IS had a higher risk for coronary occlusion, requiring stent deployment, compared with those who underwent ViV-OS (54% vs 3%, respectively; P < 0.001. There was no difference in mortality at 3 years between the 2 groups (P = 0.59).<br />Conclusions: Patients who underwent ViV-IS had a very high incidence of coronary compromise that can be safely and effectively treated. In the setting of a systematic coronary protection strategy, ViV-OS and ViV-IS provide similar mid-term outcome, and periprocedural hemodynamic status (following adjustment for age, sex, and true internal diameter).<br />Competing Interests: Funding Support and Author Disclosures Dr Jilaihawi has received consulting fees from Edwards Lifesciences, St. Jude Medical, and Venous MedTech. Dr Makkar has received consulting fees from Cordis and Medtronic and research grants from Abbott and Edwards Lifesciences. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.<br /> (Copyright © 2023 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)
- Subjects :
- Male
Humans
Female
Aortic Valve diagnostic imaging
Aortic Valve surgery
Retrospective Studies
Treatment Outcome
Prosthesis Failure
Prosthesis Design
Hemodynamics
Stents
Transcatheter Aortic Valve Replacement adverse effects
Transcatheter Aortic Valve Replacement methods
Aortic Valve Stenosis diagnostic imaging
Aortic Valve Stenosis surgery
Aortic Valve Stenosis etiology
Heart Valve Prosthesis adverse effects
Bioprosthesis adverse effects
Coronary Occlusion etiology
Heart Valve Prosthesis Implantation adverse effects
Subjects
Details
- Language :
- English
- ISSN :
- 1876-7605
- Volume :
- 16
- Issue :
- 5
- Database :
- MEDLINE
- Journal :
- JACC. Cardiovascular interventions
- Publication Type :
- Academic Journal
- Accession number :
- 36922040
- Full Text :
- https://doi.org/10.1016/j.jcin.2023.01.381