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

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

  • Bleiziffer S Department of Cardiovascular Surgery, German Heart Center Munich, Technische Universität München, Munich, Germany.
  • Erlebach M Department of Cardiovascular Surgery, German Heart Center Munich, Technische Universität München, Munich, Germany.
  • Simonato M Division of Cardiovascular Surgery, Department of Surgery, Escola Paulista de Medicina - UNIFESP, São Paulo, Brazil.
  • Pibarot P Department of Medicine, Laval University, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec City, Québec, Canada.
  • Webb J Centre for Heart Valve Innovation, St. Paul's Hospital, Vancouver, British Columbia, Canada.
  • Capek L University Hospital of Bern, Bern, Switzerland.
  • Windecker S University Hospital of Bern, Bern, Switzerland.
  • George I Columbia University, New York, USA.
  • Sinning JM University of Bonn, Bonn, Germany.
  • Horlick E Peter Munk Cardiac Centre, University Health Network, Toronto, Canada.
  • Napodano M University of Padova, Padova, Italy.
  • Holzhey DM University of Leipzig, Leipzig, Germany.
  • Petursson P Sahlgrenska University Hospital, Gothenburg, Sweden.
  • Cerillo A Fondazione Toscana Gabriele Monasterio, Pisa, Italy.
  • Bonaros N Innsbruck Medical University, Innsbruck, Austria.
  • Ferrari E Cardiocentro Ticino, Lugano, Switzerland.
  • Cohen MG University of Miami, Miami, Florida, USA.
  • Baquero G University of Miami, Miami, Florida, USA.
  • Jones TL University of Washington, Seattle, Washington, USA.
  • Kalra A Harrington Heart & Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA.
  • Reardon MJ Houston Methodist, Houston, Texas, USA.
  • Chhatriwalla A Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA.
  • Gama Ribeiro V Centro Hospitalar Vila Nova de Gaia, Vila Nova de Gaia, Portugal.
  • Alnasser S Peter Munk Cardiac Centre, University Health Network, Toronto, Canada.
  • Van Mieghem NM Erasmus Medical Center, Rotterdam, The Netherlands.
  • Rustenbach CJ Heartcenter, Department of Cardiovascular Surgery, University Hospital Cologne, Cologne, Germany.
  • Schofer J Albertinen Herzzentrum, Hamburg, Germany.
  • Garcia S Minneapolis VA Healthcare System, University of Minnesota, Minneapolis, Minnesota, USA.
  • Zeus T University Hospital Duesseldorf, Duesseldorf, Germany.
  • Champagnac D Clinique du Tonkin, Villeurbanne, France.
  • Bekeredjian R University of Heidelberg, Heidelberg, Germany.
  • Kornowski R Rabin Medical Center, Petah Tikva, Israel.
  • Lange R Department of Cardiovascular Surgery, German Heart Center Munich, Technische Universität München, Munich, Germany.
  • Dvir D Centre for Heart Valve Innovation, St. Paul's Hospital, Vancouver, British Columbia, Canada.
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  • 2018-01-21
Published in:
  • Heart (British Cardiac Society). - 2018
prosthetic heart valves
transcatheter valve interventions
valve disease surgery
valvular heart disease
Aged
Aged, 80 and over
Aortic Valve
Aortic Valve Stenosis
Bioprosthesis
Body Mass Index
Echocardiography
Female
Heart Valve Prosthesis
Hemodynamics
Humans
Incidence
Male
Outcome Assessment, Health Care
Postoperative Complications
Predictive Value of Tests
Prosthesis Design
Prosthesis Failure
Reoperation
Risk Assessment
Risk Factors
Transcatheter Aortic Valve Replacement
English 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.
Language
  • English
Open access status
closed
Identifiers
Persistent URL
https://sonar.ch/global/documents/185093
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