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Bioprosthetic Valve Leaflet Displacement During Valve-in-Valve Intervention: An Ex Vivo Bench Study.
- Source :
-
JACC. Cardiovascular interventions [JACC Cardiovasc Interv] 2020 Mar 23; Vol. 13 (6), pp. 667-678. Date of Electronic Publication: 2020 Feb 26. - Publication Year :
- 2020
-
Abstract
- Objectives: The aim of this study was to examine the effect of different transcatheter heart valves (THVs) on valve leaflet displacement when deployed within bioprosthetic surgical valves and, thereby, risk for coronary obstruction.<br />Background: Coronary obstruction is a potentially devastating complication during valve-in-valve (ViV) transcatheter aortic valve replacement. Strategies such as provisional stenting and intentional bioprosthetic valve leaflet laceration have been developed to mitigate this risk. Alternatively, the use of a THV that retracts the bioprosthetic leaflet away from the coronary ostium may prevent coronary obstruction.<br />Methods: A 25-mm J-Valve, a 26-mm Evolut Pro, and a 23-mm JenaValve were implanted into both a 25-mm Trifecta surgical valve and a 25-mm Mitroflow surgical valve. A 23-mm and a 26-mm SAPIEN 3 were deployed into the Trifecta and Mitroflow, respectively. Displacement of the surgical valve leaflets (retraction vs. expansion) was measured with implantation of each THV by measuring displacement angle and maximal displacement distance.<br />Results: Within both the Trifecta and Mitroflow valves, implantation of the J-Valve and JenaValve resulted in retraction of the surgical valve leaflets, and placement of the Evolut Pro and SAPIEN 3 resulted in tubular expansion of the surgical valve leaflets. There were significant differences in displacement angles and distances between both the J-Valve and JenaValve and the SAPIEN 3 and Evolut Pro (p < 0.0001).<br />Conclusions: ViV implantation with new-generation THVs that directly interact with bioprosthetic valve leaflets results in surgical valve leaflet retraction. This might mitigate the risk for coronary obstruction in selected cases of ViV transcatheter aortic valve replacement and also facilitate coronary reaccess after ViV TAVR.<br /> (Copyright © 2020 American College of Cardiology Foundation. All rights reserved.)
- Subjects :
- Coronary Stenosis etiology
Equipment Failure Analysis
Heart Valve Prosthesis Implantation adverse effects
Humans
Materials Testing
Prosthesis Design
Risk Assessment
Risk Factors
Transcatheter Aortic Valve Replacement adverse effects
Bioprosthesis
Coronary Stenosis prevention & control
Heart Valve Prosthesis
Heart Valve Prosthesis Implantation instrumentation
Prosthesis Failure
Transcatheter Aortic Valve Replacement instrumentation
Subjects
Details
- Language :
- English
- ISSN :
- 1876-7605
- Volume :
- 13
- Issue :
- 6
- Database :
- MEDLINE
- Journal :
- JACC. Cardiovascular interventions
- Publication Type :
- Academic Journal
- Accession number :
- 32113932
- Full Text :
- https://doi.org/10.1016/j.jcin.2019.10.021