Haemodynamic outcomes following aortic valve-in-valve procedure

BACKGROUND AND OBJECTIVES: Transcatheter aortic valve-in-valve implantation (ViV) has emerged as a valuable technique to treat failed surgical bioprostheses (BPs) in patients with high risk for redo surgical aortic valve replacement (SAVR). Small BP size (≤21 mm), stenotic pattern of degeneration an...

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Autores principales: Zenses, Anne-Sophie, Dahou, Abdellaziz, Salaun, Erwan, Clavel, Marie-Annick, Rodés-Cabau, Josep, Ong, Géraldine, Guzzetti, Ezéquiel, Côté, Mélanie, De Larochellière, Robert, Paradis, Jean-Michel, Doyle, Daniel, Mohammadi, Siamak, Dumont, Éric, Chamandi, Chekrallah, Rodriguez-Gabella, Tania, Rieu, Régis, Pibarot, Philippe
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6045709/
https://www.ncbi.nlm.nih.gov/pubmed/30018783
http://dx.doi.org/10.1136/openhrt-2018-000854
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author Zenses, Anne-Sophie
Dahou, Abdellaziz
Salaun, Erwan
Clavel, Marie-Annick
Rodés-Cabau, Josep
Ong, Géraldine
Guzzetti, Ezéquiel
Côté, Mélanie
De Larochellière, Robert
Paradis, Jean-Michel
Doyle, Daniel
Mohammadi, Siamak
Dumont, Éric
Chamandi, Chekrallah
Rodriguez-Gabella, Tania
Rieu, Régis
Pibarot, Philippe
author_facet Zenses, Anne-Sophie
Dahou, Abdellaziz
Salaun, Erwan
Clavel, Marie-Annick
Rodés-Cabau, Josep
Ong, Géraldine
Guzzetti, Ezéquiel
Côté, Mélanie
De Larochellière, Robert
Paradis, Jean-Michel
Doyle, Daniel
Mohammadi, Siamak
Dumont, Éric
Chamandi, Chekrallah
Rodriguez-Gabella, Tania
Rieu, Régis
Pibarot, Philippe
author_sort Zenses, Anne-Sophie
collection PubMed
description BACKGROUND AND OBJECTIVES: Transcatheter aortic valve-in-valve implantation (ViV) has emerged as a valuable technique to treat failed surgical bioprostheses (BPs) in patients with high risk for redo surgical aortic valve replacement (SAVR). Small BP size (≤21 mm), stenotic pattern of degeneration and pre-existing prosthesis–patient mismatch (PPM) have been associated with worse clinical outcomes after ViV. However, no study has evaluated the actual haemodynamic benefit associated with ViV. This study aims to compare haemodynamic status observed at post-ViV, pre-ViV and early after initial SAVR and to determine the factors associated with worse haemodynamic outcomes following ViV, including the rates of high residual gradient and ‘haemodynamic futility’. METHODS: Early post-SAVR, pre-ViV and post-ViV echocardiographic data of 79 consecutive patients who underwent aortic ViV at our institution were retrospectively analysed. The primary study endpoint was suboptimal valve haemodynamics (SVH) following ViV defined by the Valve Academic Research Consortium 2 as the presence of high residual aortic mean gradient (≥20 mm Hg) and/or at least moderate aortic regurgitation (AR). Haemodynamic futility of ViV was defined as <10 mm Hg decrease in mean aortic gradient and no improvement in AR compared with pre-ViV. RESULTS: SVH was found in 61% of patients (57% high residual gradient, 4% moderate AR) after ViV versus 24% early after SAVR. Pre-existing PPM and BP mode of failure by stenosis were independently associated with the primary endpoint (OR: 2.87; 95% CI 1.08 to 7.65; p=0.035 and OR: 3.02; 95% CI 1.08 to 8.42; p=0.035, respectively) and with the presence of high residual gradient (OR: 4.38; 95% CI 1.55 to 12.37; p=0.005 and OR: 5.37; 95% CI 1.77 to 16.30; p=0.003, respectively) following ViV. Criteria of ViV haemodynamic futility were met in 7.6% overall and more frequently in patients with pre-existing PPM and stenotic BP (18.5%) compared with other patients (2.0%). ViV restored haemodynamic function to early post-SAVR level in only 34% of patients. CONCLUSION: Although ViV was associated with significant haemodynamic improvement compared with pre-ViV in >90% of patients, more than half harboured SVH outcome. Furthermore, only one-third of patients had a restoration of valve haemodynamic function to the early post-SAVR level. Pre-existing PPM and stenosis pattern of BP degeneration were the main factors associated with SVH and haemodynamic futility following ViV. These findings provide strong support for the prevention of PPM at the time of initial SAVR and careful preprocedural patient screening.
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spelling pubmed-60457092018-07-17 Haemodynamic outcomes following aortic valve-in-valve procedure Zenses, Anne-Sophie Dahou, Abdellaziz Salaun, Erwan Clavel, Marie-Annick Rodés-Cabau, Josep Ong, Géraldine Guzzetti, Ezéquiel Côté, Mélanie De Larochellière, Robert Paradis, Jean-Michel Doyle, Daniel Mohammadi, Siamak Dumont, Éric Chamandi, Chekrallah Rodriguez-Gabella, Tania Rieu, Régis Pibarot, Philippe Open Heart Valvular Heart Disease BACKGROUND AND OBJECTIVES: Transcatheter aortic valve-in-valve implantation (ViV) has emerged as a valuable technique to treat failed surgical bioprostheses (BPs) in patients with high risk for redo surgical aortic valve replacement (SAVR). Small BP size (≤21 mm), stenotic pattern of degeneration and pre-existing prosthesis–patient mismatch (PPM) have been associated with worse clinical outcomes after ViV. However, no study has evaluated the actual haemodynamic benefit associated with ViV. This study aims to compare haemodynamic status observed at post-ViV, pre-ViV and early after initial SAVR and to determine the factors associated with worse haemodynamic outcomes following ViV, including the rates of high residual gradient and ‘haemodynamic futility’. METHODS: Early post-SAVR, pre-ViV and post-ViV echocardiographic data of 79 consecutive patients who underwent aortic ViV at our institution were retrospectively analysed. The primary study endpoint was suboptimal valve haemodynamics (SVH) following ViV defined by the Valve Academic Research Consortium 2 as the presence of high residual aortic mean gradient (≥20 mm Hg) and/or at least moderate aortic regurgitation (AR). Haemodynamic futility of ViV was defined as <10 mm Hg decrease in mean aortic gradient and no improvement in AR compared with pre-ViV. RESULTS: SVH was found in 61% of patients (57% high residual gradient, 4% moderate AR) after ViV versus 24% early after SAVR. Pre-existing PPM and BP mode of failure by stenosis were independently associated with the primary endpoint (OR: 2.87; 95% CI 1.08 to 7.65; p=0.035 and OR: 3.02; 95% CI 1.08 to 8.42; p=0.035, respectively) and with the presence of high residual gradient (OR: 4.38; 95% CI 1.55 to 12.37; p=0.005 and OR: 5.37; 95% CI 1.77 to 16.30; p=0.003, respectively) following ViV. Criteria of ViV haemodynamic futility were met in 7.6% overall and more frequently in patients with pre-existing PPM and stenotic BP (18.5%) compared with other patients (2.0%). ViV restored haemodynamic function to early post-SAVR level in only 34% of patients. CONCLUSION: Although ViV was associated with significant haemodynamic improvement compared with pre-ViV in >90% of patients, more than half harboured SVH outcome. Furthermore, only one-third of patients had a restoration of valve haemodynamic function to the early post-SAVR level. Pre-existing PPM and stenosis pattern of BP degeneration were the main factors associated with SVH and haemodynamic futility following ViV. These findings provide strong support for the prevention of PPM at the time of initial SAVR and careful preprocedural patient screening. BMJ Publishing Group 2018-07-09 /pmc/articles/PMC6045709/ /pubmed/30018783 http://dx.doi.org/10.1136/openhrt-2018-000854 Text en © Author(s) (or their employer(s)) 2018. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
spellingShingle Valvular Heart Disease
Zenses, Anne-Sophie
Dahou, Abdellaziz
Salaun, Erwan
Clavel, Marie-Annick
Rodés-Cabau, Josep
Ong, Géraldine
Guzzetti, Ezéquiel
Côté, Mélanie
De Larochellière, Robert
Paradis, Jean-Michel
Doyle, Daniel
Mohammadi, Siamak
Dumont, Éric
Chamandi, Chekrallah
Rodriguez-Gabella, Tania
Rieu, Régis
Pibarot, Philippe
Haemodynamic outcomes following aortic valve-in-valve procedure
title Haemodynamic outcomes following aortic valve-in-valve procedure
title_full Haemodynamic outcomes following aortic valve-in-valve procedure
title_fullStr Haemodynamic outcomes following aortic valve-in-valve procedure
title_full_unstemmed Haemodynamic outcomes following aortic valve-in-valve procedure
title_short Haemodynamic outcomes following aortic valve-in-valve procedure
title_sort haemodynamic outcomes following aortic valve-in-valve procedure
topic Valvular Heart Disease
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6045709/
https://www.ncbi.nlm.nih.gov/pubmed/30018783
http://dx.doi.org/10.1136/openhrt-2018-000854
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