The International Trifecta^TM and Epic^TM Valve-in-Valve Registry: Insights Into Clinical & Hemodynamic Outcomes.

IF 2.1 3区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Catheterization and Cardiovascular Interventions Pub Date : 2025-03-27 DOI:10.1002/ccd.31492

Matthias Raschpichler, Mohamed Abdel-Wahab, Nick Curzen, Manuel Wilbring, Christoph Dubois, Kayan Lam, Gloria Faerber, Jana Nagel, Holger Thiele, Michael A Borger

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引用次数: 0

Abstract

Background: Little is known about the clinical and hemodynamic outcome of valve-in-valve transcatheter aortic valve replacement (ViV-TAVR) for failed Trifecta surgical aortic bioprotheses.

Aims: We aimed to compare outcomes of valve-in-valve transcatheter aortic valve replacement (ViV-TAVR into failed Trifecta^TM vs. ViV-TAVR into a standard aortic bioprosthetic valve with internally mounted leaflets (Epic^TM, Abbott, Minneapolis, MN).

Methods: Data of consecutive patients who underwent ViV-TAVR into either failed Trifecta^TM or Epic^TM bioprostheses between October 2015 and June 2020 were retrospectively collected within the International Trifecta and Epic Valve-in-Valve Registry, and analyzed for a primary composite outcome of 30-day mortality and/or coronary obstruction (CO), defined as: (1) CO resulting in myocardial infarction and/or cardiogenic shock, or (2) CO requiring emergent coronary intervention.

Results: A total of 76 patients (49 Trifecta, 27 Epic) with a median age of 80 years (interquartile range [IQR] 75.0; 82.0]) and a median Society of Thoracic Surgeons-score of 5.4 (IQR 4.0; 9.8) were identified. Coronary protection techniques were more frequently performed in Trifecta than Epic patients (29.6% vs. 0%, p = 0.01). The primary composite outcome was observed in three Trifecta versus five Epic cases (6.1% vs. 20%, p = 0.1), which included one case of CO following ViV-TAVR into Epic requiring stenting. Increased rates of patient-prosthesis mismatch (PPM) following valve-in-Epic were found (41.7% vs. 75%, p = 0.08). Survival at a median of 365 days was 86.2% and did not differ between groups (log-rank p = 0.37).

Conclusions: Compared to a stented prosthesis without increased risk of CO, ViV-TAVR into Trifecta prostheses can be performed with low risk of CO and acceptable short-term clinical outcomes. As the rate of post-ViV PPM is substantial for both prostheses, careful patient selection is warranted. (NCT05389631).

查看原文本刊更多论文

国际triectatm和EpicTM瓣中瓣注册：临床和血流动力学结果的见解。

背景：经导管瓣内主动脉瓣置换术（ViV-TAVR）治疗失败的三叶主动脉生物假体的临床和血流动力学结果知之甚少。目的：我们的目的是比较经导管瓣中瓣主动脉瓣置换术(ViV-TAVR植入失败的TrifectaTM与ViV-TAVR植入内装小叶的标准主动脉生物假体瓣膜的结果（EpicTM, Abbott, Minneapolis， MN）。方法：回顾性收集2015年10月至2020年6月期间接受ViV-TAVR植入失败的TrifectaTM或EpicTM生物假体的连续患者的数据，并分析30天死亡率和/或冠状动脉阻塞（CO）的主要复合结局，定义为：(1)CO导致心肌梗死和/或心源性休克，或(2)CO需要紧急冠状动脉介入治疗。结果：共有76例患者（49例Trifecta， 27例Epic），中位年龄为80岁(四分位数间距[IQR] 75.0；82.0])，胸外科学会评分中位数为5.4 (IQR 4.0；9.8)。冠状动脉保护技术在三氟替尼组比Epic组更常见（29.6%比0%，p = 0.01）。主要综合结果在3例Trifecta和5例Epic患者中观察到（6.1% vs. 20%, p = 0.1），其中包括1例因ViV-TAVR进入Epic后需要支架置入的CO患者。epic瓣膜置换术后患者-假体不匹配率（PPM）增加（41.7% vs. 75%, p = 0.08）。365天的中位生存率为86.2%，组间无差异（log-rank p = 0.37）。结论：与不增加CO风险的支架假体相比，ViV-TAVR植入Trifecta假体可实现低CO风险和可接受的短期临床结果。由于两种假体的viv后PPM率都很高，因此必须谨慎选择患者。(NCT05389631)。

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来源期刊

Catheterization and Cardiovascular Interventions 医学-心血管系统

CiteScore

5.40

自引率

8.70%

发文量

419

审稿时长

2 months

期刊介绍： Catheterization and Cardiovascular Interventions is an international journal covering the broad field of cardiovascular diseases. Subject material includes basic and clinical information that is derived from or related to invasive and interventional coronary or peripheral vascular techniques. The journal focuses on material that will be of immediate practical value to physicians providing patient care in the clinical laboratory setting. To accomplish this, the journal publishes Preliminary Reports and Work In Progress articles that complement the traditional Original Studies, Case Reports, and Comprehensive Reviews. Perspective and insight concerning controversial subjects and evolving technologies are provided regularly through Editorial Commentaries furnished by members of the Editorial Board and other experts. Articles are subject to double-blind peer review and complete editorial evaluation prior to any decision regarding acceptability.