Bioprosthetic Valve Remodeling in Nonfracturable Surgical Valves : Impact on THV Expansion and Hydrodynamic Performance
Copyright © 2023 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved..
BACKGROUND: There are limited data on the effect of bioprosthetic valve remodeling (BVR) on transcatheter heart valve (THV) expansion and function following valve-in-valve (VIV) transcatheter aortic valve replacement (TAVR) in a nonfracturable surgical heart valve (SHV).
OBJECTIVES: This study sought to assess the impact of BVR of nonfracturable SHVs on THVs after VIV implantation.
METHODS: VIV TAVR was performed using 23-mm SAPIEN3 (S3, Edwards Lifesciences) or 23/26-mm Evolut Pro (Medtronic) THVs implanted in 21/23-mm Trifecta (Abbott Structural Heart) and 21/23-mm Hancock (Medtronic) SHVs with BVR performed with a noncompliant TRUE balloon (Bard Peripheral Vascular Inc). Hydrodynamic assessment was performed, and multimodality imaging including micro-computed tomography was performed before and after BVR to assess THV and SHV expansion.
RESULTS: BVR resulted in limited improvement of THV expansion. The largest gain in expansion was observed for the S3 in the 21-mm Trifecta with up to a 12.7% increase in expansion at the outflow of the valve. Minimal change was observed at the level of the sewing ring. The Hancock was less amenable to BVR with lower final expansion dimensions than the Trifecta. BVR also resulted in notable surgical post flaring of up to 17.6°, which was generally more marked with the S3 than with the Evolut Pro. Finally, BVR resulted in very limited improvement in hydrodynamic function. Severe pinwheeling was observed with the S3, which improved slightly but persisted despite BVR.
CONCLUSIONS: When performing VIV TAVR inside a Trifecta and Hancock SHV, BVR had a limited impact on THV expansion and resulted in SHV post flaring with unknown consequences on coronary obstruction risk and long-term THV function.
| Errataetall: |
CommentIn: JACC Cardiovasc Interv. 2023 Jul 10;16(13):1609-1611. - PMID 37294227 |
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| Medienart: |
E-Artikel |
| Erscheinungsjahr: |
2023 |
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| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:16 |
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| Enthalten in: |
JACC. Cardiovascular interventions - 16(2023), 13 vom: 10. Juli, Seite 1594-1608 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Meier, David [VerfasserIn] |
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| Links: |
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| Themen: |
Bioprosthetic valve fracture |
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| Anmerkungen: |
Date Completed 14.07.2023 Date Revised 19.09.2023 published: Print-Electronic CommentIn: JACC Cardiovasc Interv. 2023 Jul 10;16(13):1609-1611. - PMID 37294227 Citation Status MEDLINE |
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| doi: |
10.1016/j.jcin.2023.03.035 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM357960009 |
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| 245 | 1 | 0 | |a Bioprosthetic Valve Remodeling in Nonfracturable Surgical Valves |b Impact on THV Expansion and Hydrodynamic Performance |
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| 500 | |a Date Completed 14.07.2023 | ||
| 500 | |a Date Revised 19.09.2023 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a CommentIn: JACC Cardiovasc Interv. 2023 Jul 10;16(13):1609-1611. - PMID 37294227 | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2023 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved. | ||
| 520 | |a BACKGROUND: There are limited data on the effect of bioprosthetic valve remodeling (BVR) on transcatheter heart valve (THV) expansion and function following valve-in-valve (VIV) transcatheter aortic valve replacement (TAVR) in a nonfracturable surgical heart valve (SHV) | ||
| 520 | |a OBJECTIVES: This study sought to assess the impact of BVR of nonfracturable SHVs on THVs after VIV implantation | ||
| 520 | |a METHODS: VIV TAVR was performed using 23-mm SAPIEN3 (S3, Edwards Lifesciences) or 23/26-mm Evolut Pro (Medtronic) THVs implanted in 21/23-mm Trifecta (Abbott Structural Heart) and 21/23-mm Hancock (Medtronic) SHVs with BVR performed with a noncompliant TRUE balloon (Bard Peripheral Vascular Inc). Hydrodynamic assessment was performed, and multimodality imaging including micro-computed tomography was performed before and after BVR to assess THV and SHV expansion | ||
| 520 | |a RESULTS: BVR resulted in limited improvement of THV expansion. The largest gain in expansion was observed for the S3 in the 21-mm Trifecta with up to a 12.7% increase in expansion at the outflow of the valve. Minimal change was observed at the level of the sewing ring. The Hancock was less amenable to BVR with lower final expansion dimensions than the Trifecta. BVR also resulted in notable surgical post flaring of up to 17.6°, which was generally more marked with the S3 than with the Evolut Pro. Finally, BVR resulted in very limited improvement in hydrodynamic function. Severe pinwheeling was observed with the S3, which improved slightly but persisted despite BVR | ||
| 520 | |a CONCLUSIONS: When performing VIV TAVR inside a Trifecta and Hancock SHV, BVR had a limited impact on THV expansion and resulted in SHV post flaring with unknown consequences on coronary obstruction risk and long-term THV function | ||
| 650 | 4 | |a Journal Article | |
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| 650 | 4 | |a TAVR | |
| 650 | 4 | |a bioprosthetic valve fracture | |
| 650 | 4 | |a bioprosthetic valve remodeling | |
| 650 | 4 | |a valve-in-valve | |
| 700 | 1 | |a Puehler, Thomas |e verfasserin |4 aut | |
| 700 | 1 | |a Lutter, Georg |e verfasserin |4 aut | |
| 700 | 1 | |a Shen, Carol |e verfasserin |4 aut | |
| 700 | 1 | |a Lai, Althea |e verfasserin |4 aut | |
| 700 | 1 | |a Gill, Hacina |e verfasserin |4 aut | |
| 700 | 1 | |a Akodad, Mariama |e verfasserin |4 aut | |
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| 700 | 1 | |a Allen, Keith B |e verfasserin |4 aut | |
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| 700 | 1 | |a Sellers, Stephanie L |e verfasserin |4 aut | |
| 700 | 1 | |a Sathananthan, Janarthanan |e verfasserin |4 aut | |
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