Transcatheter valve-in-valve therapy using 6 different devices in 4 anatomic positions: Clinical outcomes and technical considerations
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Transcatheter valve-in-valve therapy using 6 different devices in 4 anatomic positions: Clinical outcomes and technical considerations : Read at the 95th Annual Meeting of the American Association for Thoracic Surgery, Seattle, Washington, April 25-29, 2015. / Conradi, Lenard; Silaschi, Miriam; Seiffert, Moritz; Lubos, Edith; Blankenberg, Stefan; Reichenspurner, Hermann; Schaefer, Ulrich; Treede, Hendrik.
In: J THORAC CARDIOV SUR, Vol. 150, No. 6, 12.2015, p. 1557-1567.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Transcatheter valve-in-valve therapy using 6 different devices in 4 anatomic positions: Clinical outcomes and technical considerations
T2 - Read at the 95th Annual Meeting of the American Association for Thoracic Surgery, Seattle, Washington, April 25-29, 2015.
AU - Conradi, Lenard
AU - Silaschi, Miriam
AU - Seiffert, Moritz
AU - Lubos, Edith
AU - Blankenberg, Stefan
AU - Reichenspurner, Hermann
AU - Schaefer, Ulrich
AU - Treede, Hendrik
N1 - Publisher Copyright: © 2015 The American Association for Thoracic Surgery.
PY - 2015/12
Y1 - 2015/12
N2 - Objectives Transcatheter valve-in-valve implantation (ViV) is emerging as a novel treatment option for patients with deteriorated bioprostheses. We report our cumulative experience using 6 types of transcatheter heart valves (THVs) in all anatomic positions. Methods Seventy-five consecutive patients (74.1 ± 12.9 years, 50.7% male (38/75), logEuroSCORE I 26.2% ± 17.8%, STS-PROM 8.8% ± 7.4%) receiving ViV procedures from 2008 to 2014 were included for analysis. Data were prospectively gathered and retrospectively analyzed. Results ViV was performed in aortic (72.0%, 54/75), mitral (22.7%, 17/75), tricuspid (2.7%, 2/75), and pulmonary (2.7%, 2/75) positions. THVs used were Edwards SAPIEN (XT)/SAPIEN3 (52.0%, 39/75), Medtronic Core Valve/Core Valve Evolut(R) (34.7%, 26/75), St Jude Portico (4.0%, 3/75), Boston Scientific Lotus (4.0%, 3/75), Jena Valve (2.7%, 2/75), and Medtronic Engager (2.7%, 2/75). Interval from index procedure to ViV was 9.3 ± 4.9 years. Access was transapical in 53.3% (40/75), transfemoral (transarterial or transvenous) in 42.7% (32/75), transaortic in 2.7% (2/75), and transjugular in 1.3% (1/75). ViV was successful in 97.3% (73/75) with 2 patients requiring sequential THV implantation for initial malpositioning. Overall immediate procedural (≤72 hours) and all-cause 30-day mortality were 2.7% (2/75) and 8.0% (6/75). Corresponding values after aortic ViV were 1.9% (1/54) and 5.6% (3/54). No periprocedural strokes or cases of coronary obstruction occurred. Paravalvular leakage was less than or equal to mild in all cases. After aortic ViV, gradients were max/mean 34.1 ± 14.2/20.1 ± 7.1 mm Hg and effective orifice area (EOA) was 1.5 ± 1.4cm. Corresponding values after mitral ViV were gradients max/mean 14.2 ± 8.2/4.7 ± 3.1 mm Hg and EOA 2.4 ± 0.9cm. Conclusions ViV can be performed in all anatomic positions with acceptable hemodynamic and clinical outcome in high-risk patients. Increasing importance of ViV can be anticipated considering growing use of surgical bioprostheses.
AB - Objectives Transcatheter valve-in-valve implantation (ViV) is emerging as a novel treatment option for patients with deteriorated bioprostheses. We report our cumulative experience using 6 types of transcatheter heart valves (THVs) in all anatomic positions. Methods Seventy-five consecutive patients (74.1 ± 12.9 years, 50.7% male (38/75), logEuroSCORE I 26.2% ± 17.8%, STS-PROM 8.8% ± 7.4%) receiving ViV procedures from 2008 to 2014 were included for analysis. Data were prospectively gathered and retrospectively analyzed. Results ViV was performed in aortic (72.0%, 54/75), mitral (22.7%, 17/75), tricuspid (2.7%, 2/75), and pulmonary (2.7%, 2/75) positions. THVs used were Edwards SAPIEN (XT)/SAPIEN3 (52.0%, 39/75), Medtronic Core Valve/Core Valve Evolut(R) (34.7%, 26/75), St Jude Portico (4.0%, 3/75), Boston Scientific Lotus (4.0%, 3/75), Jena Valve (2.7%, 2/75), and Medtronic Engager (2.7%, 2/75). Interval from index procedure to ViV was 9.3 ± 4.9 years. Access was transapical in 53.3% (40/75), transfemoral (transarterial or transvenous) in 42.7% (32/75), transaortic in 2.7% (2/75), and transjugular in 1.3% (1/75). ViV was successful in 97.3% (73/75) with 2 patients requiring sequential THV implantation for initial malpositioning. Overall immediate procedural (≤72 hours) and all-cause 30-day mortality were 2.7% (2/75) and 8.0% (6/75). Corresponding values after aortic ViV were 1.9% (1/54) and 5.6% (3/54). No periprocedural strokes or cases of coronary obstruction occurred. Paravalvular leakage was less than or equal to mild in all cases. After aortic ViV, gradients were max/mean 34.1 ± 14.2/20.1 ± 7.1 mm Hg and effective orifice area (EOA) was 1.5 ± 1.4cm. Corresponding values after mitral ViV were gradients max/mean 14.2 ± 8.2/4.7 ± 3.1 mm Hg and EOA 2.4 ± 0.9cm. Conclusions ViV can be performed in all anatomic positions with acceptable hemodynamic and clinical outcome in high-risk patients. Increasing importance of ViV can be anticipated considering growing use of surgical bioprostheses.
KW - structural valve deterioration
KW - transcatheter
KW - valve-in-valve
UR - http://www.scopus.com/inward/record.url?scp=84948086699&partnerID=8YFLogxK
U2 - 10.1016/j.jtcvs.2015.08.065
DO - 10.1016/j.jtcvs.2015.08.065
M3 - SCORING: Journal article
C2 - 26403870
AN - SCOPUS:84948086699
VL - 150
SP - 1557
EP - 1567
JO - J THORAC CARDIOV SUR
JF - J THORAC CARDIOV SUR
SN - 0022-5223
IS - 6
ER -
