Author + information
- Keith B. Allena,b,
- Adnan Chhatriwallaa,b,
- David Cohena,b,
- Sanjeev Aggarwala,b,
- Suzanne Barona,b,
- Anthony Harta,b,
- John Saxona,b,
- Anthony Bavrya,b,
- Thomas Beavera,b,
- Ashkan Karimia,b,
- Michael Lima,b,
- Richard Leea,b and
- A. Michael Borkona,b
Background: Valve-in-valve TAVR in small surgical valves may result in post implant gradients. We reported bench testing on the feasibility of sewing ring fracture using a high-pressure balloon (accepted STS, Jan 2017). Our clinical experience with this technique is reported here.
Methods: Fracturing the surgical valve ring to facilitate ViV TAVR was performed in 7 patients at 3 US centers. Procedural variables including hemodynamic gradients are reported here.
Results: Surgical valves treated included Magna (2), Mitroflow (2), Mosaic (2) and Trifecta (1) with valve sizes of 19mm (2), 21mm (3) and 23mm (2) using self (5) and balloon expandable (2) transcatheter aortic valves. Access for ViV TAVR was TF (6) and transcarotid (1). A Bard TRU (6) or Atlas Gold (1) high pressure balloon 1mm larger than the surgical valve size was used to fracture the surgical valve. Mean preoperative prosthetic valve gradient was 53mm Hg (range 36-80). Following ViV TAVR, a residual mean gradient of 35mm Hg (range 22-50) was further reduced to a mean gradient of 10mm Hg (range 3-13) following fracture. There were no complications with median LOS of 3 days (1-7). Valve fracture is demonstrated in Fig 1.
Conclusions: Residual gradients following ViV TAVR can be safely reduced by fracturing the surgical valve sewing ring with a high-pressure balloon. Optimal transcatheter valve expansion using this technique can optimize hemodynamics and may positively impact long term TAVR durability and warrants further investigation.
Poster Hall, Hall C
Saturday, March 18, 2017, 3:45 p.m.-4:30 p.m.
Session Title: Interventional Cardiology: TAVR 3
Abstract Category: 17. Interventional Cardiology: Aortic Valve Disease
Presentation Number: 1243-190
- 2017 American College of Cardiology Foundation