Author + information
- Jörg Kempfert1,
- Axel Unbehaun2,
- Matheus Simonato dos Santos3,
- Sabine Bleiziffer4,
- Gabriel Aldea5,
- Lukas Capek6,
- Tanja Rudolph7,
- Jochen Wöhrle8,
- Nicolas Van Mieghem9,
- Konstantinos Spargias10,
- Marco Barbanti11,
- Stephan Windecker12 and
- Danny Dvir11
- 1Deutsches Herzzentrum Berlin, Berlin, Germany
- 2German Heart Center Berlin, Berlin, Germany
- 3Federal University of Sao Paulo, Sao Paulo, São Paulo, Brazil
- 4German Heart Center Munich, Munich, Germany
- 5University of Washington, Seattle, Washington, United States
- 6Inselspital Bern, Bern, Switzerland
- 7University of Cologne, Cologne, Germany
- 8University Hospital Ulm, Ulm, Germany
- 9Thoraxcenter, Erasmus Medical Center, Rotterdam, Netherlands
- 10Hygeia Hospital, Athens, Greece
- 11Centre for Heart Valve Innovation, St. Paul's and Vancouver General Hospital, Vancouver, British Columbia, Canada
- 12University Hospital Bern, Bern, Switzerland
Transcatheter aortic valve-in-valve implantation has become an established therapy for patients with failed surgical aortic bioprostheses. In patients with bioprostheses that have externally mounted leaflets (Mitroflow, Livanova and Trifecta [M/T]), concerns have been raised regarding the risk for coronary obstruction.
Based on the Valve-in-Valve International Data (VIVID), 1792 patients with a failed stented aortic bioprosthesis were analyzed. M/T bioprostheses have been previously implanted in 467 patients and their baseline characteristics and clinical outcomes were compared to 1325 patients with standard stented bioprostheses. At baseline, patients in the M/T group were older (79.9 ± 7.1 vs. 77.9 ± 9 years, p < 0.001) and were more frequently female gender (53.4 vs. 38.2%, p<0.001), had smaller bioprosthesis label sizes (22.4 ± 1.9 M/T vs. 23.4 ± 2.1 mm others; p < 0.001) and similarly smaller true ID (18.5 ± 1.9 M/T vs. 20 ± 2.2 mm others; p < 0.001). In general, there were no significant differences in procedural details (type of anesthesia, access site, re-dilation, or device malposition) except for a higher percentage of self-expandable devices used in the M/T group (62.1% M/T vs. 50.4% others, p<0.001).
Coronary obstruction after valve-in-valve occurred more frequently in the M/T group (4.5% vs. 0.6%; p<0.001). There was greater 30-day mortality in the M/T group (5.4% M/T vs. 3%; p = 0.01). Postprocedural transvalvular gradients were significantly higher in the M/T group (18.8 ± 9.7 vs. 16.7 ± 8.7 mmHg; p < 0.001). There were no further relevant differences in other VARC events including stroke or paravalvular leakage. There was no difference in 1-year survival (log-rank p = 0.46).
In this large multicenter data collection, transcatheter aortic valve-in-valves in M/T surgical valves were associated with a very significant increased incidence of coronary obstruction, in addition to higher post procedural gradients and early mortality in comparison to conventional stented surgical bioprostheses valve in valve procedures. However, 1-year mortality did not differ between the groups.
STRUCTURAL: Valvular Disease: Aortic