Bioprosthetic Valve Remodeling in Nonfracturable Surgical Valves: Impact on THV Expansion and Hydrodynamic Performance.
TAVR
bioprosthetic valve fracture
bioprosthetic valve remodeling
valve-in-valve
Journal
JACC. Cardiovascular interventions
ISSN: 1876-7605
Titre abrégé: JACC Cardiovasc Interv
Pays: United States
ID NLM: 101467004
Informations de publication
Date de publication:
10 07 2023
10 07 2023
Historique:
received:
11
01
2023
revised:
13
02
2023
accepted:
21
03
2023
medline:
14
7
2023
pubmed:
9
6
2023
entrez:
9
6
2023
Statut:
ppublish
Résumé
There are limited data on the effect of bioprosthetic valve remodeling (BVR) on transcatheter heart valve (THV) expansion and function following valve-in-valve (VIV) transcatheter aortic valve replacement (TAVR) in a nonfracturable surgical heart valve (SHV). This study sought to assess the impact of BVR of nonfracturable SHVs on THVs after VIV implantation. VIV TAVR was performed using 23-mm SAPIEN3 (S3, Edwards Lifesciences) or 23/26-mm Evolut Pro (Medtronic) THVs implanted in 21/23-mm Trifecta (Abbott Structural Heart) and 21/23-mm Hancock (Medtronic) SHVs with BVR performed with a noncompliant TRUE balloon (Bard Peripheral Vascular Inc). Hydrodynamic assessment was performed, and multimodality imaging including micro-computed tomography was performed before and after BVR to assess THV and SHV expansion. BVR resulted in limited improvement of THV expansion. The largest gain in expansion was observed for the S3 in the 21-mm Trifecta with up to a 12.7% increase in expansion at the outflow of the valve. Minimal change was observed at the level of the sewing ring. The Hancock was less amenable to BVR with lower final expansion dimensions than the Trifecta. BVR also resulted in notable surgical post flaring of up to 17.6°, which was generally more marked with the S3 than with the Evolut Pro. Finally, BVR resulted in very limited improvement in hydrodynamic function. Severe pinwheeling was observed with the S3, which improved slightly but persisted despite BVR. When performing VIV TAVR inside a Trifecta and Hancock SHV, BVR had a limited impact on THV expansion and resulted in SHV post flaring with unknown consequences on coronary obstruction risk and long-term THV function.
Sections du résumé
BACKGROUND
There are limited data on the effect of bioprosthetic valve remodeling (BVR) on transcatheter heart valve (THV) expansion and function following valve-in-valve (VIV) transcatheter aortic valve replacement (TAVR) in a nonfracturable surgical heart valve (SHV).
OBJECTIVES
This study sought to assess the impact of BVR of nonfracturable SHVs on THVs after VIV implantation.
METHODS
VIV TAVR was performed using 23-mm SAPIEN3 (S3, Edwards Lifesciences) or 23/26-mm Evolut Pro (Medtronic) THVs implanted in 21/23-mm Trifecta (Abbott Structural Heart) and 21/23-mm Hancock (Medtronic) SHVs with BVR performed with a noncompliant TRUE balloon (Bard Peripheral Vascular Inc). Hydrodynamic assessment was performed, and multimodality imaging including micro-computed tomography was performed before and after BVR to assess THV and SHV expansion.
RESULTS
BVR resulted in limited improvement of THV expansion. The largest gain in expansion was observed for the S3 in the 21-mm Trifecta with up to a 12.7% increase in expansion at the outflow of the valve. Minimal change was observed at the level of the sewing ring. The Hancock was less amenable to BVR with lower final expansion dimensions than the Trifecta. BVR also resulted in notable surgical post flaring of up to 17.6°, which was generally more marked with the S3 than with the Evolut Pro. Finally, BVR resulted in very limited improvement in hydrodynamic function. Severe pinwheeling was observed with the S3, which improved slightly but persisted despite BVR.
CONCLUSIONS
When performing VIV TAVR inside a Trifecta and Hancock SHV, BVR had a limited impact on THV expansion and resulted in SHV post flaring with unknown consequences on coronary obstruction risk and long-term THV function.
Identifiants
pubmed: 37294230
pii: S1936-8798(23)00634-9
doi: 10.1016/j.jcin.2023.03.035
pii:
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
1594-1608Commentaires et corrections
Type : CommentIn
Type : CommentIn
Type : CommentIn
Informations de copyright
Copyright © 2023 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
Déclaration de conflit d'intérêts
Funding Support and Author Disclosures Dr Meier is supported by the Swiss National Science Foundation (grant P2LAP3_199561) and the SICPA foundation. Dr Akodad is supported by MUSE-Explore (Montpellier University) and Federation Française de Cardiologie. Dr Tzimas is supported by the Fondation Vaudoise de Cardiologie and the SICPA foundation. Dr Puehler is a consultant to Abbott. Dr Lutter is a consultant for Edwards Lifesciences, Medtronic, and Abbott. Dr Akodad has received research funding from Medtronic and Biotronik. Dr Chhatriwalla has received a research grant from Boston Scientific; is on the Speakers Bureau for Edwards Lifesciences and Medtronic Inc; and is a proctor for Edwards Lifesciences and Medtronic Inc. Dr Wood is a consultant to and has received research funding from Edwards Lifesciences and Abbott. Dr Leipsic holds institutional CT core lab contracts with Edwards, Abbott, Medtronic, Boston Scientific, and PI Cardia. Dr Webb is a consultant to and has received research funding from Edwards Lifesciences, Abbott, and ViVitro Labs. Dr Sellers is a consultant for Edwards Lifesciences, Anteris, and Medtronic; and has received research support from Vivitro Labs, Edwards Lifesciences, Medtronic, and HeartFlow. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.