Transcatheter Replacement of Failed Bioprosthetic Valves Large Multicenter Assessment of the Effect of Implantation Depth on Hemodynamics After Aortic Valve-in-Valve

被引：112

作者：

Simonato, Matheus ^{[1
,2
]}

Webb, John ^{[1
]}

Kornowski, Ran ^{[3
]}

Vahanian, Alec ^{[4
]}

Frerker, Christian ^{[5
]}

Nissen, Henrik ^{[6
]}

Bleiziffer, Sabine ^{[7
]}

Duncan, Alison ^{[8
]}

Rodes-Cabau, Josep ^{[9
]}

Attizzani, Guilherme F. ^{[10
]}

Horlick, Eric ^{[11
]}

Latib, Azeem ^{[12
]}

Bekeredjian, Raffi ^{[13
]}

Barbanti, Marco ^{[14
]}

Lefevre, Thierry ^{[15
]}

Cerillo, Alfredo ^{[16
]}

Hernandez, Jose Mara ^{[17
]}

Bruschi, Giuseppe ^{[18
]}

Spargias, Konstantinos ^{[19
]}

Iadanza, Alessandro ^{[20
]}

Brecker, Stephen ^{[21
]}

Palma, Jose Honorio ^{[2
]}

Finkelstein, Ariel ^{[22
]}

Abdel-Wahab, Mohamed ^{[23
]}

Lemos, Pedro ^{[24
]}

Petronio, Anna Sonia ^{[25
]}

Champagnac, Didier ^{[26
]}

Sinning, Jan-Malte ^{[27
]}

Salizzoni, Stefano ^{[28
]}

Napodano, Massimo ^{[29
]}

Fiorina, Claudia ^{[30
]}

Marzocchi, Antonio ^{[31
]}

Leon, Martin ^{[32
]}

Dvir, Danny ^{[1
]}

机构：

[1] St Pauls Hosp, Dept Cardiol, Ctr Heart Valve Innovat, Vancouver, BC V6Z 1Y6, Canada

[2] Escola Paulista Med UNIFESP, Div Cardiovasc Surg, Sao Paulo, Brazil

[3] Rabin Med Ctr, Intervent Cardiol Inst, Dept Cardiol, Petah Tivka, Israel

[4] Hop Bichat Claude Bernard, Dept Cardiol, F-75877 Paris 18, France

[5] Asklepios Klin, Dept Cardiol, Hamburg, Germany

[6] Odense Univ Hosp, Dept Cardiol, DK-5000 Odense, Denmark

[7] Deutsch Herzzentrum Munich, Dept Cardiovasc Surg, Munich, Germany

[8] Royal Brompton & Harefield, Echocardiog Serv, London, England

[9] Univ Laval, Quebec Heart & Lung Inst, Quebec City, PQ, Canada

[10] Case Western Res Univ, Cardiovasc Imaging Core Lab, Cleveland, OH USA

[11] Univ Toronto, Univ Hlth Network, Peter Munk Cardiac Ctr, Toronto, ON M5S 1A1, Canada

[12] Univ Milan, Osped San Raffaele, Cardiol Interventist Emodinam, Via Prinetti 29, I-20127 Milan, Italy

[13] Univ Klinikum Heidelberg, Zentrum Innere Med, Kardiol Angiol & Pneumol, Heidelberg, Germany

[14] Osped Ferrarotto, Div Cardiol, Catania, Italy

[15] Hop Jacques Cartier, Inst Cardiovasc Paris Sud, Massy, France

[16] Osped Cuore G Pasquinucci, Fdn Toscana Gabriele Monasterio, Massa, Italy

[17] Hosp Univ Virgen de la Victoria, Unidad Hemodinam & Cardiol Intervencionista, Malaga, Spain

[18] Osped Niguarda Ca Granda, Dipartimento Cardiotoracovasc, Milan, Italy

[19] Hygeia Hosp, Transcatheter Heart Valve Dept, Athens, Greece

[20] Azienda Osped Univ Senese, Dipartimento Cardio Toracico, UOC Emodinam, Siena, Italy

[21] St George Hosp, Cardiac Catheterisat Labs, London, England

[22] Tel Aviv Univ, Tel Aviv Sourasky Med Ctr, Div Cardiol, Cardiac Catheterizat Unit, IL-69978 Tel Aviv, Israel

[23] Segeberger Kliniken, Herzzentrums Segeberger Kliniken, Bad Segeberg, Germany

[24] Univ Sao Paulo, Fac Med, Hosp Clin, Serv Hemodinam & Cardiol Intervencionista Inst Co, BR-05508 Sao Paulo, Brazil

[25] Univ Pisa, Lab Emodinam, I-56100 Pisa, Italy

[26] Clin Tonkin, Cardiol Intervent, Villeurbanne, France

[27] Univ Klinikum Bonn, Med Klin Innere Med Kardiol Angiol & Pneumol 2, Bonn, Germany

[28] Citta Salute & Sci Molinette Hosp, Dept Cardiovasc & Thorac Surg, Turin, Italy

[29] Univ Padua, Dept Cardiac Thorac & Vasc Sci, I-35100 Padua, Italy

[30] Spedali Civil Brescia, Cardiothorac & Vasc Dept, I-25125 Brescia, Italy

[31] Policlin St Orsola Malpighi, Inst Cardiol, Bologna, Italy

[32] Columbia Univ, Ctr Intervent Vasc Therapy, Med Ctr, New York, NY USA

来源：

CIRCULATION-CARDIOVASCULAR INTERVENTIONS | 2016年 / 9卷 / 06期

关键词：

aortic valve; bioprosthesis; hemodynamics; multivariate analysis; transcatheter aortic valve replacement; PATIENT-PROSTHESIS MISMATCH; HEART-VALVE; SURGICAL VALVES; OUTCOMES; STENOSIS; PERFORMANCE; COREVALVE; SOCIETY; SURGERY; VITRO;

D O I：

10.1161/CIRCINTERVENTIONS.115.003651

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Background-Transcatheter valve implantation inside failed bioprosthetic surgical valves (valve-in-valve [ViV]) may offer an advantage over reoperation. Supra-annular transcatheter valve position may be advantageous in achieving better hemodynamics after ViV. Our objective was to define targets for implantation that would improve hemodynamics after ViV. Methods and Results-Cases from the Valve-in-Valve International Data (VIVID) registry were analyzed using centralized core laboratory assessment blinded to clinical events. Multivariate analysis was performed to identify independent predictors of elevated postprocedural gradients (mean >= 20 mm Hg). Optimal implantation depths were defined by receiver operating characteristic curve. A total of 292 consecutive patients (age, 78.9 +/- 8.7 years; 60.3% male; 157 CoreValve Evolut and 135 Sapien XT) were evaluated. High implantation was associated with significantly lower rates of elevated gradients in comparison with low implantation (CoreValve Evolut, 15% versus 34.2%; P=0.03 and Sapien XT, 18.5% versus 43.5%; P=0.03, respectively). Optimal implantation depths were defined: CoreValve Evolut, 0 to 5 mm; Sapien XT, 0 to 2 mm (0-10% frame height); sensitivities, 91.3% and 88.5%, respectively. The strongest independent correlate for elevated gradients after ViV was device position (high: odds ratio, 0.22; confidence interval, 0.1-0.52; P=0.001), in addition to type of device used (CoreValve Evolut: odds ratio, 0.5; confidence interval, 0.28-0.88; P=0.02) and surgical valve mechanism of failure (stenosis/mixed baseline failure: odds ratio, 3.12; confidence interval, 1.51-6.45; P=0.002). Conclusions-High implantation inside failed bioprosthetic valves is a strong independent correlate of lower postprocedural gradients in both self-and balloon-expandable transcatheter valves. These clinical evaluations support specific implantation targets to optimize hemodynamics after ViV.

引用

页数：11

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