In vitro evaluation of implantation depth in valve-in-valve using different transcatheter heart valves.

Simonato, Matheus; Azadani, Ali N; Webb, John; Leipsic, Jonathon; Kornowski, Ran; Vahanian, Alec; Wood, David; Piazza, Nicolo; Kodali, Susheel; Ye, Jian; Whisenant, Brian; Gaia, Diego; Aziz, Mina; Pasala, Tilak; Mehilli, Julinda; Wijeysundera, Harindra C; Tchetche, Didier; Moat, Neil; Teles, Rui; Petronio, Anna Sonia; ... (2016). In vitro evaluation of implantation depth in valve-in-valve using different transcatheter heart valves. EuroIntervention, 12(7), pp. 909-917. Europa Digital & Publishing 10.4244/EIJV12I7A149

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AIMS Transcatheter heart valve (THV) implantation in failed bioprosthetic valves (valve-in-valve [ViV]) offers an alternative therapy for high-risk patients. Elevated post-procedural gradients are a significant limitation of aortic ViV. Our objective was to assess the relationship between depth of implantation and haemodynamics. METHODS AND RESULTS Commercially available THVs used for ViV were included in the analysis (CoreValve Evolut, SAPIEN XT and the Portico valve). THVs were implanted in small surgical valves (label size 19 mm) to simulate boundary conditions. Custom-mounted pulse duplicators registered relevant haemodynamic parameters. Twenty-eight experiments were performed (13 CVE, 5 SXT and 10 Portico). Ranges of depth of implantation were: CVE: -1.2 mm to 15.7 mm; SXT: -2.2 mm to 7.5 mm; Portico: 1.4 mm to 12.1 mm. Polynomial regression established a relationship between depth of implantation and valvular mean gradients (CVE: p<0.001; SXT: p=0.01; Portico: p=0.002), as well as with EOA (CVE: p<0.001; SXT: p=0.02; Portico valve: p=0.003). In addition, leaflet coaptation was better in the high implantation experiments for all valves. CONCLUSIONS The current comprehensive bench testing assessment demonstrates the importance of high device position for the attainment of optimal haemodynamics during aortic ViV procedures.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology

UniBE Contributor:

Windecker, Stephan

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1774-024X

Publisher:

Europa Digital & Publishing

Language:

English

Submitter:

Judith Liniger

Date Deposited:

29 Nov 2016 08:09

Last Modified:

29 Nov 2016 08:09

Publisher DOI:

10.4244/EIJV12I7A149

PubMed ID:

27639744

URI:

https://boris.unibe.ch/id/eprint/89668

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