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Heart. 2018 May;104(10):828-834. doi: 10.1136/heartjnl-2017-312422. Epub 2018 Jan 19.

Incidence, predictors and clinical outcomes of residual stenosis after aortic valve-in-valve.

Author information

1
Department of Cardiovascular Surgery, German Heart Center Munich, Technische Universität München, Munich, Germany.
2
Insure (Institute for Translational Cardiac Surgery), Department of Cardiovascular Surgery, German Heart Center Munich, Technische Universität München, Munich, Germany.
3
Division of Cardiovascular Surgery, Department of Surgery, Escola Paulista de Medicina - UNIFESP, São Paulo, Brazil.
4
Centre for Heart Valve Innovation, St. Paul's Hospital, Vancouver, British Columbia, Canada.
5
Department of Medicine, Laval University, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec City, Québec, Canada.
6
University Hospital of Bern, Bern, Switzerland.
7
Columbia University, New York, USA.
8
University of Bonn, Bonn, Germany.
9
Peter Munk Cardiac Centre, University Health Network, Toronto, Canada.
10
University of Padova, Padova, Italy.
11
University of Leipzig, Leipzig, Germany.
12
Sahlgrenska University Hospital, Gothenburg, Sweden.
13
Fondazione Toscana Gabriele Monasterio, Pisa, Italy.
14
Innsbruck Medical University, Innsbruck, Austria.
15
Cardiocentro Ticino, Lugano, Switzerland.
16
University of Miami, Miami, Florida, USA.
17
Southern Illinois University, Springfield, Illinois, USA.
18
University of Washington, Seattle, Washington, USA.
19
Harrington Heart & Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA.
20
Division of Cardiovascular Medicine, Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.
21
Houston Methodist, Houston, Texas, USA.
22
Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA.
23
Centro Hospitalar Vila Nova de Gaia, Vila Nova de Gaia, Portugal.
24
Erasmus Medical Center, Rotterdam, The Netherlands.
25
Heartcenter, Department of Cardiovascular Surgery, University Hospital Cologne, Cologne, Germany.
26
Albertinen Herzzentrum, Hamburg, Germany.
27
Minneapolis VA Healthcare System, University of Minnesota, Minneapolis, Minnesota, USA.
28
University Hospital Duesseldorf, Duesseldorf, Germany.
29
Clinique du Tonkin, Villeurbanne, France.
30
University of Heidelberg, Heidelberg, Germany.
31
Rabin Medical Center, Petah Tikva, Israel.

Abstract

OBJECTIVE:

We aimed to analyse the incidence of prosthesis-patient mismatch (PPM) and elevated gradients after aortic valve in valve (ViV), and to evaluate predictors and associations with clinical outcomes of this adverse event.

METHODS:

A total of 910 aortic ViV patients were investigated. Elevated residual gradients were defined as ≥20 mm Hg. PPM was identified based on the indexed effective orifice area (EOA), measured by echocardiography, and patient body mass index (BMI). Moderate and severe PPM (cases) were defined by European Association of Cardiovascular Imaging (EACVI) criteria and compared with patients without PPM (controls).

RESULTS:

Moderate or greater PPM was found in 61% of the patients, and severe in 24.6%. Elevated residual gradients were found in 27.9%. Independent risk factors for the occurrence of lower indexed EOA and therefore severe PPM were higher gradients of the failed bioprosthesis at baseline (unstandardised beta -0.023; 95% CI -0.032 to -0.014; P<0.001), a stented (vs a stentless) surgical bioprosthesis (unstandardised beta -0.11; 95% CI -0.161 to -0.071; P<0.001), higher BMI (unstandardised beta -0.01; 95% CI -0.013 to -0.007; P<0.001) and implantation of a SAPIEN/SAPIEN XT/SAPIEN 3 transcatheter device (unstandardised beta -0.064; 95% CI -0.095 to -0.032; P<0.001). Neither severe PPM nor elevated gradients had an association with VARC II-defined outcomes or 1-year survival (90.9% severe vs 91.5% moderate vs 89.3% none, P=0.44).

CONCLUSIONS:

Severe PPM and elevated gradients after aortic ViV are very common but were not associated with short-term survival and clinical outcomes. The long-term effect of poor post-ViV haemodynamics on clinical outcomes requires further evaluation.

KEYWORDS:

prosthetic heart valves; transcatheter valve interventions; valve disease surgery; valvular heart disease

PMID:
29352008
DOI:
10.1136/heartjnl-2017-312422
[Indexed for MEDLINE]

Conflict of interest statement

Competing interests: DD is a consultant for Edwards Lifesciences, Medtronic and Abbott. SB is a proctor and consultant for Medtronic and a proctor for Boston Scientific and JenaValve. RL is a member of the Medtronic advisory board. SG is a consultant for Edwards Lifesciences, Medtronic, Surmodics, Osprey Medical and Boston Scientific and also repots research grants from Edwards Lifesciences and VA Office of Research and Development. EF reports consulting and proctoring for Edwards Lifesciences. DH is a member of the Medtronic advisory board. TZ reports lecture fees from Edwards Lifesciences and Medtronic. MJR is a consultant for Medtronic, Abbott and Boston Scientific. SW reports institutional research grants from Amgen, Abbott, Boston Scientific, Biotronik and St. Jude Medical. NMvM reports research grant support from Medtronic, Abbott, Edwards Lifesciences, Boston Scientific, Claret and Essential Medical. NB has received research grants from Edwards Lifesciences and speaker honoraria from Edwards Lifesciences, Medtronic and Abbott. AC is part of the speakers bureau for Edwards Lifesciences, Medtronic and Abbott, and also reports proctoring for Medtronic. J-MS reports research grants and speaker honoraria from Medtronic, Edwards Lifesciences, Boston Scientific, and Abbott. No other conflicts of interest were reported.

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