Hendrik Ruge, Melchior Burri, Julia Schreyer, Teodora-Cristiana Georgescu, Derk Frank, Won-Keun Kim, Ole de Backer, Martin Beyer, Andreas Schäfer, Chiara Fraccaro, Giuseppe Tarantini, Erion Xhepa, Michael Joner, Markus Krane, Héctor Alfonso Alvarez Covarrubias
{"title":"瓣内瓣TAVI中生物假体瓣膜破裂：失败的周围主动脉生物假体的临床和超声心动图结果-一项多中心登记。","authors":"Hendrik Ruge, Melchior Burri, Julia Schreyer, Teodora-Cristiana Georgescu, Derk Frank, Won-Keun Kim, Ole de Backer, Martin Beyer, Andreas Schäfer, Chiara Fraccaro, Giuseppe Tarantini, Erion Xhepa, Michael Joner, Markus Krane, Héctor Alfonso Alvarez Covarrubias","doi":"10.1002/ccd.31686","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Data comparing clinical and hemodynamic outcomes of bioprosthetic valve fracturing (BVF) and \"standard\"-postdilatation during valve-in-valve transcatheter heart valve implantation (ViV-TAVI) are lacking. The authors aimed to analyze hemodynamic and clinical outcomes of BVF compared to \"standard\"-postdilatation during ViV-TAVI.</p><p><strong>Methods: </strong>The REDUCE registry included patients who underwent ViV-TAVI within a Perimount surgical aortic valve bioprosthesis (Edwards Lifesciences, USA). Procedures were categorized to no postdilatation, \"standard\"-postdilatation and BVF. Hemodynamic and clinical outcomes at 30 days were collected and compared. A linear regression model was built to predict mean aortic gradient after ViV-TAVI.</p><p><strong>Results: </strong>A total of 240 patients from six European sites were included. Median age was 78 years [IQR 70; 83], logistic EuroSCORE calculated 20.0%[IQR 12.2; 33.1] and 159 patients (66%) were male. One hundred fourty-four Perimount valves (60%) had a true internal diameter (ID) ≤ 21 mm. Self-expanding valves (SEV) and ballon-expandable valves (BEV) were used in 60% and 40% of cases, respectively. One hundred sixteen procedures (48%) were executed without postdilatation, in 88 procedures (37%) \"standard\"-postdilatation and in 36 procedures (15%) BVF was used. 30-day survival was 93.3%. VARC-3 device success at 30 days was 71%. A multivariable regression analysis of the mean aortic gradient after ViV-TAVI showed a significant association with surgical valve size (-0.84 mmHg, p = 0.001; per 1 mm surgical valve size increase), execution of postdilatation (-3.25 mmHg, p = 0.007) and type of transcatheter heart valve (SEV: -7.31 mmHg, p < 0.001).</p><p><strong>Conclusions: </strong>When performing ViV-TAVI within a Perimount surgical aortic bioprosthesis with a true ID ≤ 21 mm, the hemodynamic valve performance is most optimal when implanting a SEV-TAV and when postdilating the TAV-in-SAV complex. BVF did not result in superior hemodynamics compared to \"standard\"-postdilatation.</p>","PeriodicalId":520583,"journal":{"name":"Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions","volume":" ","pages":""},"PeriodicalIF":0.0000,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Bioprosthetic Valve Fracturing in Valve-in-Valve TAVI: Clinical and Echocardiographic Outcomes in Failing Perimount Aortic Bioprostheses-A Multicenter Registry.\",\"authors\":\"Hendrik Ruge, Melchior Burri, Julia Schreyer, Teodora-Cristiana Georgescu, Derk Frank, Won-Keun Kim, Ole de Backer, Martin Beyer, Andreas Schäfer, Chiara Fraccaro, Giuseppe Tarantini, Erion Xhepa, Michael Joner, Markus Krane, Héctor Alfonso Alvarez Covarrubias\",\"doi\":\"10.1002/ccd.31686\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Data comparing clinical and hemodynamic outcomes of bioprosthetic valve fracturing (BVF) and \\\"standard\\\"-postdilatation during valve-in-valve transcatheter heart valve implantation (ViV-TAVI) are lacking. The authors aimed to analyze hemodynamic and clinical outcomes of BVF compared to \\\"standard\\\"-postdilatation during ViV-TAVI.</p><p><strong>Methods: </strong>The REDUCE registry included patients who underwent ViV-TAVI within a Perimount surgical aortic valve bioprosthesis (Edwards Lifesciences, USA). Procedures were categorized to no postdilatation, \\\"standard\\\"-postdilatation and BVF. Hemodynamic and clinical outcomes at 30 days were collected and compared. A linear regression model was built to predict mean aortic gradient after ViV-TAVI.</p><p><strong>Results: </strong>A total of 240 patients from six European sites were included. Median age was 78 years [IQR 70; 83], logistic EuroSCORE calculated 20.0%[IQR 12.2; 33.1] and 159 patients (66%) were male. One hundred fourty-four Perimount valves (60%) had a true internal diameter (ID) ≤ 21 mm. Self-expanding valves (SEV) and ballon-expandable valves (BEV) were used in 60% and 40% of cases, respectively. One hundred sixteen procedures (48%) were executed without postdilatation, in 88 procedures (37%) \\\"standard\\\"-postdilatation and in 36 procedures (15%) BVF was used. 30-day survival was 93.3%. VARC-3 device success at 30 days was 71%. A multivariable regression analysis of the mean aortic gradient after ViV-TAVI showed a significant association with surgical valve size (-0.84 mmHg, p = 0.001; per 1 mm surgical valve size increase), execution of postdilatation (-3.25 mmHg, p = 0.007) and type of transcatheter heart valve (SEV: -7.31 mmHg, p < 0.001).</p><p><strong>Conclusions: </strong>When performing ViV-TAVI within a Perimount surgical aortic bioprosthesis with a true ID ≤ 21 mm, the hemodynamic valve performance is most optimal when implanting a SEV-TAV and when postdilating the TAV-in-SAV complex. BVF did not result in superior hemodynamics compared to \\\"standard\\\"-postdilatation.</p>\",\"PeriodicalId\":520583,\"journal\":{\"name\":\"Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2025-06-19\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1002/ccd.31686\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1002/ccd.31686","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
Bioprosthetic Valve Fracturing in Valve-in-Valve TAVI: Clinical and Echocardiographic Outcomes in Failing Perimount Aortic Bioprostheses-A Multicenter Registry.
Background: Data comparing clinical and hemodynamic outcomes of bioprosthetic valve fracturing (BVF) and "standard"-postdilatation during valve-in-valve transcatheter heart valve implantation (ViV-TAVI) are lacking. The authors aimed to analyze hemodynamic and clinical outcomes of BVF compared to "standard"-postdilatation during ViV-TAVI.
Methods: The REDUCE registry included patients who underwent ViV-TAVI within a Perimount surgical aortic valve bioprosthesis (Edwards Lifesciences, USA). Procedures were categorized to no postdilatation, "standard"-postdilatation and BVF. Hemodynamic and clinical outcomes at 30 days were collected and compared. A linear regression model was built to predict mean aortic gradient after ViV-TAVI.
Results: A total of 240 patients from six European sites were included. Median age was 78 years [IQR 70; 83], logistic EuroSCORE calculated 20.0%[IQR 12.2; 33.1] and 159 patients (66%) were male. One hundred fourty-four Perimount valves (60%) had a true internal diameter (ID) ≤ 21 mm. Self-expanding valves (SEV) and ballon-expandable valves (BEV) were used in 60% and 40% of cases, respectively. One hundred sixteen procedures (48%) were executed without postdilatation, in 88 procedures (37%) "standard"-postdilatation and in 36 procedures (15%) BVF was used. 30-day survival was 93.3%. VARC-3 device success at 30 days was 71%. A multivariable regression analysis of the mean aortic gradient after ViV-TAVI showed a significant association with surgical valve size (-0.84 mmHg, p = 0.001; per 1 mm surgical valve size increase), execution of postdilatation (-3.25 mmHg, p = 0.007) and type of transcatheter heart valve (SEV: -7.31 mmHg, p < 0.001).
Conclusions: When performing ViV-TAVI within a Perimount surgical aortic bioprosthesis with a true ID ≤ 21 mm, the hemodynamic valve performance is most optimal when implanting a SEV-TAV and when postdilating the TAV-in-SAV complex. BVF did not result in superior hemodynamics compared to "standard"-postdilatation.
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