Matched comparison of next- and early-generation balloon-expandable transcatheter heart valve implantations in failed surgical aortic bioprostheses
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Matched comparison of next- and early-generation balloon-expandable transcatheter heart valve implantations in failed surgical aortic bioprostheses. / Seiffert, Moritz; Treede, Hendrik; Schofer, Joachim; Linke, Axel; Woehrle, Jochen; Baumbach, Hardy; Mehilli, Julinda; Bapat, Vinayak; Simonato, Matheus; Walther, Thomas; Kullmer, Mathias; Boekstegers, Peter; Ensminger, Stephan; Kurz, Thomas; Eltchaninoff, Hélène; Rastan, Ardawan; Werner, Nicolas; de Weger, Arend; Frerker, Christian; Lauer, Bernward; Muller, Olivier; Whisenant, Brian; Thukkani, Arun; Weisz, Giora; Dvir, Danny.
in: EUROINTERVENTION, Jahrgang 14, Nr. 4, 20.07.2018, S. e397-e404.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - Matched comparison of next- and early-generation balloon-expandable transcatheter heart valve implantations in failed surgical aortic bioprostheses
AU - Seiffert, Moritz
AU - Treede, Hendrik
AU - Schofer, Joachim
AU - Linke, Axel
AU - Woehrle, Jochen
AU - Baumbach, Hardy
AU - Mehilli, Julinda
AU - Bapat, Vinayak
AU - Simonato, Matheus
AU - Walther, Thomas
AU - Kullmer, Mathias
AU - Boekstegers, Peter
AU - Ensminger, Stephan
AU - Kurz, Thomas
AU - Eltchaninoff, Hélène
AU - Rastan, Ardawan
AU - Werner, Nicolas
AU - de Weger, Arend
AU - Frerker, Christian
AU - Lauer, Bernward
AU - Muller, Olivier
AU - Whisenant, Brian
AU - Thukkani, Arun
AU - Weisz, Giora
AU - Dvir, Danny
PY - 2018/7/20
Y1 - 2018/7/20
N2 - AIMS: Transcatheter valve-in-valve implantation (VinV) is established for the treatment of degenerated surgical bioprostheses in patients at high operative risk. Our aim was to report on the first large assessment of VinV with next-generation balloon-expandable transcatheter heart valves.METHODS AND RESULTS: After SAPIEN XT or SAPIEN 3 VinV, 514 patients were analysed using an inverse probability of treatment weighting. Standardised clinical and haemodynamic outcomes were compared, and core laboratory evaluation of implantation depth was performed. Thirty-day all-cause mortality was 0.6% and 3.5% for SAPIEN 3 and SAPIEN XT (p=0.077). Residual transprosthetic gradient ≥20 mmHg was observed in 38.3% (SAPIEN 3) and 35.7% (SAPIEN XT) of patients (p=0.627) with increased rates in small bioprostheses (≤21 mm true ID). In SAPIEN 3 VinV, low implantation depth >20% THV stent frame length was associated with a higher rate of elevated transaortic gradients (p=0.048). Similarly, an implantation depth >5 mm was linked to more pacemaker implantations (p=0.01). Overall, a trend towards higher pacemaker implantation rates was observed after SAPIEN 3 VinV (6% vs. 2.5% in SAPIEN XT, p=0.071).CONCLUSIONS: Transcatheter aortic VinV with the balloon-expandable SAPIEN XT or SAPIEN 3 was similarly safe and effective. However, residual stenosis remains a concern, particularly in smaller bioprostheses and with increasing implantation depth.
AB - AIMS: Transcatheter valve-in-valve implantation (VinV) is established for the treatment of degenerated surgical bioprostheses in patients at high operative risk. Our aim was to report on the first large assessment of VinV with next-generation balloon-expandable transcatheter heart valves.METHODS AND RESULTS: After SAPIEN XT or SAPIEN 3 VinV, 514 patients were analysed using an inverse probability of treatment weighting. Standardised clinical and haemodynamic outcomes were compared, and core laboratory evaluation of implantation depth was performed. Thirty-day all-cause mortality was 0.6% and 3.5% for SAPIEN 3 and SAPIEN XT (p=0.077). Residual transprosthetic gradient ≥20 mmHg was observed in 38.3% (SAPIEN 3) and 35.7% (SAPIEN XT) of patients (p=0.627) with increased rates in small bioprostheses (≤21 mm true ID). In SAPIEN 3 VinV, low implantation depth >20% THV stent frame length was associated with a higher rate of elevated transaortic gradients (p=0.048). Similarly, an implantation depth >5 mm was linked to more pacemaker implantations (p=0.01). Overall, a trend towards higher pacemaker implantation rates was observed after SAPIEN 3 VinV (6% vs. 2.5% in SAPIEN XT, p=0.071).CONCLUSIONS: Transcatheter aortic VinV with the balloon-expandable SAPIEN XT or SAPIEN 3 was similarly safe and effective. However, residual stenosis remains a concern, particularly in smaller bioprostheses and with increasing implantation depth.
KW - Aortic Valve
KW - Aortic Valve Stenosis
KW - Bioprosthesis
KW - Heart Valve Prosthesis
KW - Humans
KW - Prosthesis Design
KW - Transcatheter Aortic Valve Replacement
KW - Treatment Outcome
U2 - 10.4244/EIJ-D-17-00546
DO - 10.4244/EIJ-D-17-00546
M3 - SCORING: Journal article
C2 - 29688174
VL - 14
SP - e397-e404
JO - EUROINTERVENTION
JF - EUROINTERVENTION
SN - 1774-024X
IS - 4
ER -