1. Current Generation Balloon-Expandable Transcatheter Valve Positioning Strategies During Aortic Valve-in-Valve Procedures and Clinical Outcomes
- Author
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Alfredo Giuseppe Cerillo, Marco Barbanti, Stephan Windecker, Massimo Napodano, Nikolaos Bonaros, Azeem Latib, Wolfgang Schoels, David Jochheim, John G. Webb, Rafael Viana dos Santos Coutinho, Sabine Bleiziffer, Felix Woitek, David A. Wood, Diego Felipe Gaia, Moritz Seiffert, Tara L. Jones, Konstantinos Spargias, Susheel Kodali, Marco Agrifoglio, Danny Dvir, Jochen Wöhrle, Mohamed Abdel-Wahab, Matheus Simonato, Joachim Schofer, Ulrich Schäfer, Jörg Kempfert, Dimytri Siqueira, Santiago Garcia, Hardy Baumbach, Didier Tchetche, and Verena Veulemans
- Subjects
Aortic valve ,Balloon Valvuloplasty ,Male ,medicine.medical_specialty ,Current generation ,Aortic Valve Insufficiency ,030204 cardiovascular system & hematology ,Intra-Aortic Balloon Pumping ,Prosthesis Design ,Sts score ,Transcatheter Aortic Valve Replacement ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,Internal medicine ,medicine ,Humans ,030212 general & internal medicine ,Heart valve ,610 Medicine & health ,Aged ,Aged, 80 and over ,Bioprosthesis ,Heart Valve Prosthesis Implantation ,business.industry ,Aortic Valve Stenosis ,Prosthesis Failure ,Balloon expandable stent ,medicine.anatomical_structure ,Treatment Outcome ,Aortic Valve ,Heart Valve Prosthesis ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business - Abstract
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 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.
- Published
- 2019
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