Outcomes of valve-in-valve transcatheter aortic valve implantation with and without bioprosthetic valve fracture.

Brinkmann, Christina; Abdel-Wahab, Mohamed; Bedogni, Francesco; Bhadra, Oliver Daniel; Charbonnier, Gaetan; Conradi, Lenard; Hildick-Smith, David; Kargoli, Faraj; Latib, Azeem; Van Mieghem, Nicolas M; Mylotte, Darren; Landes, Uri; Pilgrim, Thomas; Stripling, Jan; Taramasso, Maurizio; Tchétché, Didier; Testa, Luca; Thiele, Holger; Webb, John; Windecker, Stephan; ... (2021). Outcomes of valve-in-valve transcatheter aortic valve implantation with and without bioprosthetic valve fracture. EuroIntervention, 17(10), pp. 848-855. Europa Digital & Publishing 10.4244/EIJ-D-21-00254

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BACKGROUND

Bioprosthetic valve fracture (BVF) is a technique to reduce gradients in valve-in-valve transcatheter aortic valve implantation (VIV-TAVI) procedures. The outcome of VIV-TAVI with BVF has not been compared with VIV-TAVI without BVF.

AIMS

The aim of this study was to evaluate the outcome of VIV-TAVI with BVF compared to VIV-TAVI without BVF.

METHODS

In total, 81 cases of BVF VIV-TAVI (BVF group) from 14 centres were compared to 79 cases of VIV-TAVI without BVF (control group).

RESULTS

VARC-2-defined device success was 93% in the BVF group and 68.4% in the control group (p<0.001). The mean transvalvular gradient decreased from 37±13 mmHg to 10.8±5.9 mmHg (p<0.001) in the BVF group and from 35±16 mmHg to 15.8±6.8 mmHg (p<0.001) in the control group with a significantly higher final gradient in the control group (p<0.001). The transvalvular gradients did not change significantly over time. In-hospital major adverse events occurred in 3.7% in the BVF group and 7.6% in the control group (p=0.325). A linear mixed model identified BVF, self-expanding transcatheter heart valves (THVs) and other surgical aortic valve (SAV) types other than Mitroflow as predictors of lower transvalvular gradients.

CONCLUSIONS

Compared to VIV-TAVI alone, VIV-TAVI with BVF resulted in a significantly lower transvalvular gradient acutely and at follow-up. Independent predictors of lower gradients were the use of self-expanding THVs and the treatment of SAVs other than Mitroflow, irrespective of BVF performance. BVF significantly reduced the gradient independently from transcatheter or surgical valve type.

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