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Current Generation Balloon-Expandable Transcatheter Valve Positioning Strategies During Aortic Valve-in-Valve Procedures and Clinical Outcomes
- Publication Year :
- 2019
- Publisher :
- Elsevier, 2019.
-
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.
- 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
Subjects
Details
- Language :
- English
- Database :
- OpenAIRE
- Accession number :
- edsair.doi.dedup.....08a4d1a004709356a6f4fe06fb05530b
- Full Text :
- https://doi.org/10.7892/boris.139121