Author + information
- John Saxon1,
- Keith Allen2,
- David Cohen2,
- Anthony Bavry3,
- Pranav Loyalka4,
- Tom Nguyen5,
- Juhana Karha6,
- Joshua Rovin7,
- Anthony Hart8,
- Suzanne Baron8,
- Danny Dvir9 and
- Adnan Chhatriwalla10
- 1Mid America Heart Institute, Kansas City, Missouri, United States
- 2Saint Luke's Mid America Heart Institute, Kansas City, Missouri, United States
- 3University of Florida Health, Gainesville, Florida, United States
- 4University of Texas Health Science Center, Houston, Texas, United States
- 5Atlanta, Georgia, United States
- 6Austin Heart, Austin, Texas, United States
- 7BayCare Medical Group, Clearwater, Florida, United States
- 8St. Luke's Mid American Heart Institute, Kansas City, Missouri, United States
- 9Centre for Heart Valve Innovation, St. Paul's and Vancouver General Hospital, Vancouver, British Columbia, Canada
- 10Saint Luke’s Mid America Heart Institute, Kansas City, Missouri, United States
Valve in Valve Transcatheter Aortic Valve Replacement (VIV TAVR) in failed surgical bioprostheses may be limited by patient prosthesis mismatch (PPM), which has been associated with decreased survival at 1 year. Bioprosthetic valve fracture (BVF) to facilitate VIV TAVR is a safe and effective method to improve procedural hemodynamics, yet the durability of hemodynamic result is not known.
We analyzed 1-month clinical and echocardiographic data from 18 patients treated with BVF at the time of VIV TAVR. BVF was performed using high-pressure balloons, typically 1 mm larger than the labeled surgical valve size.
VIV TAVR and BVF were successful in all 18 patients using self-expanding (n=9) and balloon-expandable (n=9) valves. Survival at 1 month was 100%. Baseline mean transvalvular gradient and aortic valve area (AVA) were 42±17 mmHg and 0.8±0.3 cm2, respectively, which improved to 19±7 mmHg and 1.0±0.3 cm2 following VIV TAVR and 8±4 mmHg and 2.0±0.6 cm2, respectively after BVF (p<0.001 for all comparisons; see Figure). At 1 month follow-up, mean gradient and AVA by echocardiography were 12±5 mmHg and 1.6±0.3 cm2, (p=0.16 and p=0.27, compared with immediate post-procedure measurements).
The immediate hemodynamic results of BVF to facilitate VIV TAVR are favorable and appear durable at 1 month. Further investigation is needed to assess long-term clinical and hemodynamic results of this novel procedure.
STRUCTURAL: Valvular Disease: Aortic