Current Generation Balloon-Expandable Transcatheter Valve Positioning Strategies During Aortic Valve-in-Valve Procedures and Clinical Outcomes
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Current Generation Balloon-Expandable Transcatheter Valve Positioning Strategies During Aortic Valve-in-Valve Procedures and Clinical Outcomes. / Simonato, Matheus; Webb, John; Bleiziffer, Sabine; Abdel-Wahab, Mohamed; Wood, David; Seiffert, Moritz; Schäfer, Ulrich; Wöhrle, Jochen; Jochheim, David; Woitek, Felix; Latib, Azeem; Barbanti, Marco; Spargias, Konstantinos; Kodali, Susheel; Jones, Tara; Tchetche, Didier; Coutinho, Rafael; Napodano, Massimo; Garcia, Santiago; Veulemans, Verena; Siqueira, Dimytri; Windecker, Stephan; Cerillo, Alfredo; Kempfert, Jörg; Agrifoglio, Marco; Bonaros, Nikolaos; Schoels, Wolfgang; Baumbach, Hardy; Schofer, Joachim; Gaia, Diego Felipe; Dvir, Danny.
In: JACC-CARDIOVASC INTE, Vol. 12, No. 16, 26.08.2019, p. 1606-1617.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Current Generation Balloon-Expandable Transcatheter Valve Positioning Strategies During Aortic Valve-in-Valve Procedures and Clinical Outcomes
AU - Simonato, Matheus
AU - Webb, John
AU - Bleiziffer, Sabine
AU - Abdel-Wahab, Mohamed
AU - Wood, David
AU - Seiffert, Moritz
AU - Schäfer, Ulrich
AU - Wöhrle, Jochen
AU - Jochheim, David
AU - Woitek, Felix
AU - Latib, Azeem
AU - Barbanti, Marco
AU - Spargias, Konstantinos
AU - Kodali, Susheel
AU - Jones, Tara
AU - Tchetche, Didier
AU - Coutinho, Rafael
AU - Napodano, Massimo
AU - Garcia, Santiago
AU - Veulemans, Verena
AU - Siqueira, Dimytri
AU - Windecker, Stephan
AU - Cerillo, Alfredo
AU - Kempfert, Jörg
AU - Agrifoglio, Marco
AU - Bonaros, Nikolaos
AU - Schoels, Wolfgang
AU - Baumbach, Hardy
AU - Schofer, Joachim
AU - Gaia, Diego Felipe
AU - Dvir, Danny
N1 - Copyright © 2019 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
PY - 2019/8/26
Y1 - 2019/8/26
N2 - OBJECTIVES: This study sought to evaluate SAPIEN 3 (S3) (Edwards Lifesciences, Irvine, California) positioning using different strategies.BACKGROUND: Aortic valve-in-valve (ViV) is associated with high risk of elevated gradients.METHODS: S3 aortic ViV procedures in stented bioprostheses were studied. Transcatheter heart valve (THV) positioning was analyzed in a centralized core lab blinded to clinical outcomes. A combined endpoint of severely elevated mean gradient (≥30 mm Hg) or pacemaker need was established. Two positioning strategies were compared: central marker method and top of S3 method. Optimal final depth was defined as S3 depth ≤20%.RESULTS: A total of 113 patients met inclusion criteria and were analyzed (76.5 ± 9.7 years of age, 65.8% male, STS score 8 ± 7.6%). THVs had incomplete shortening in comparison to fully expanded valves (92 ± 3.4%), and expansion was more complete in optimal positioning cases compared with others (93.2 ± 2.7% vs. 91.5 ± 3.5%; p = 0.027). The central marker method demonstrated greater correlation with final implantation depth than the top of S3 method (R2 of 0.48 and 0.14; p < 0.001 and p = 0.001, respectively). The combined endpoint rate was 4.3% in the optimal (higher than 3 mm) implantation group, 12% in the intermediate group, and 50% in the low group (p < 0.001). There were no cases of THV embolization. In cases with central marker higher than 3 mm, 72.4% had optimal final depth. In those with central marker higher than 6 mm, 90% had optimal final depth.CONCLUSIONS: Optimal S3 positioning in aortic ViV is associated with better outcomes. Central marker positioning is more reliable than top of S3 positioning. Central marker bottom position should be 3 mm to 6 mm above the ring.
AB - OBJECTIVES: This study sought to evaluate SAPIEN 3 (S3) (Edwards Lifesciences, Irvine, California) positioning using different strategies.BACKGROUND: Aortic valve-in-valve (ViV) is associated with high risk of elevated gradients.METHODS: S3 aortic ViV procedures in stented bioprostheses were studied. Transcatheter heart valve (THV) positioning was analyzed in a centralized core lab blinded to clinical outcomes. A combined endpoint of severely elevated mean gradient (≥30 mm Hg) or pacemaker need was established. Two positioning strategies were compared: central marker method and top of S3 method. Optimal final depth was defined as S3 depth ≤20%.RESULTS: A total of 113 patients met inclusion criteria and were analyzed (76.5 ± 9.7 years of age, 65.8% male, STS score 8 ± 7.6%). THVs had incomplete shortening in comparison to fully expanded valves (92 ± 3.4%), and expansion was more complete in optimal positioning cases compared with others (93.2 ± 2.7% vs. 91.5 ± 3.5%; p = 0.027). The central marker method demonstrated greater correlation with final implantation depth than the top of S3 method (R2 of 0.48 and 0.14; p < 0.001 and p = 0.001, respectively). The combined endpoint rate was 4.3% in the optimal (higher than 3 mm) implantation group, 12% in the intermediate group, and 50% in the low group (p < 0.001). There were no cases of THV embolization. In cases with central marker higher than 3 mm, 72.4% had optimal final depth. In those with central marker higher than 6 mm, 90% had optimal final depth.CONCLUSIONS: Optimal S3 positioning in aortic ViV is associated with better outcomes. Central marker positioning is more reliable than top of S3 positioning. Central marker bottom position should be 3 mm to 6 mm above the ring.
KW - Aged
KW - Aged, 80 and over
KW - Aortic Valve/diagnostic imaging
KW - Aortic Valve Insufficiency/diagnostic imaging
KW - Aortic Valve Stenosis/diagnostic imaging
KW - Balloon Valvuloplasty/adverse effects
KW - Bioprosthesis
KW - Female
KW - Heart Valve Prosthesis
KW - Heart Valve Prosthesis Implantation/adverse effects
KW - Humans
KW - Male
KW - Prosthesis Design
KW - Prosthesis Failure
KW - Risk Factors
KW - Transcatheter Aortic Valve Replacement/adverse effects
KW - Treatment Outcome
U2 - 10.1016/j.jcin.2019.05.057
DO - 10.1016/j.jcin.2019.05.057
M3 - SCORING: Journal article
C2 - 31439340
VL - 12
SP - 1606
EP - 1617
JO - JACC-CARDIOVASC INTE
JF - JACC-CARDIOVASC INTE
SN - 1936-8798
IS - 16
ER -