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Transcatheter Valve-in-Valve Procedures for Bioprosthetic Valve Dysfunction in Patients With Rheumatic vs. Non-Rheumatic Valvular Heart Disease

Background: Bioprosthetic heart valve has limited durability and lower long-term performance especially in rheumatic heart disease (RHD) patients that are often subject to multiple redo operations. Minimally invasive procedures, such as transcatheter valve-in-valve (ViV) implantation, may offer an a...

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Autores principales: Lopes, Mariana Pezzute, Rosa, Vitor Emer Egypto, Palma, José Honório, Vieira, Marcelo Luiz Campos, Fernandes, Joao Ricardo Cordeiro, de Santis, Antonio, Spina, Guilherme Sobreira, Fonseca, Rafael de Jesus, de Sá Marchi, Mauricio F., Abizaid, Alexandre, de Brito, Fábio Sândoli, Tarasoutchi, Flavio, Sampaio, Roney Orismar, Ribeiro, Henrique Barbosa
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8373457/
https://www.ncbi.nlm.nih.gov/pubmed/34422923
http://dx.doi.org/10.3389/fcvm.2021.694339
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author Lopes, Mariana Pezzute
Rosa, Vitor Emer Egypto
Palma, José Honório
Vieira, Marcelo Luiz Campos
Fernandes, Joao Ricardo Cordeiro
de Santis, Antonio
Spina, Guilherme Sobreira
Fonseca, Rafael de Jesus
de Sá Marchi, Mauricio F.
Abizaid, Alexandre
de Brito, Fábio Sândoli
Tarasoutchi, Flavio
Sampaio, Roney Orismar
Ribeiro, Henrique Barbosa
author_facet Lopes, Mariana Pezzute
Rosa, Vitor Emer Egypto
Palma, José Honório
Vieira, Marcelo Luiz Campos
Fernandes, Joao Ricardo Cordeiro
de Santis, Antonio
Spina, Guilherme Sobreira
Fonseca, Rafael de Jesus
de Sá Marchi, Mauricio F.
Abizaid, Alexandre
de Brito, Fábio Sândoli
Tarasoutchi, Flavio
Sampaio, Roney Orismar
Ribeiro, Henrique Barbosa
author_sort Lopes, Mariana Pezzute
collection PubMed
description Background: Bioprosthetic heart valve has limited durability and lower long-term performance especially in rheumatic heart disease (RHD) patients that are often subject to multiple redo operations. Minimally invasive procedures, such as transcatheter valve-in-valve (ViV) implantation, may offer an attractive alternative, although data is lacking. The aim of this study was to evaluate the baseline characteristics and clinical outcomes in rheumatic vs. non-rheumatic patients undergoing ViV procedures for severe bioprosthetic valve dysfunction. Methods: Single center, prospective study, including consecutive patients undergoing transcatheter ViV implantation in aortic, mitral and tricuspid position, from May 2015 to September 2020. RHD was defined according to clinical history, previous echocardiographic and surgical findings. Results: Among 106 patients included, 69 had rheumatic etiology and 37 were non-rheumatic. Rheumatic patients had higher incidence of female sex (73.9 vs. 43.2%, respectively; p = 0.004), atrial fibrillation (82.6 vs. 45.9%, respectively; p < 0.001), and 2 or more prior surgeries (68.1 vs. 32.4%, respectively; p = 0.001). Although, device success was similar between groups (75.4 vs. 89.2% in rheumatic vs. non-rheumatic, respectively; p = 0.148), there was a trend toward higher 30-day mortality rates in the rheumatic patients (21.7 vs. 5.4%, respectively; p = 0.057). Still, at median follow-up of 20.7 [5.1–30.4] months, cumulative mortality was similar between both groups (p = 0.779). Conclusion: Transcatheter ViV implantation is an acceptable alternative to redo operations in the treatment of patients with RHD and severe bioprosthetic valve dysfunction. Despite similar device success rates, rheumatic patients present higher 30-day mortality rates with good mid-term clinical outcomes. Future studies with a larger number of patients and follow-up are still warranted, to firmly conclude on the role transcatheter ViV procedures in the RHD population.
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spelling pubmed-83734572021-08-19 Transcatheter Valve-in-Valve Procedures for Bioprosthetic Valve Dysfunction in Patients With Rheumatic vs. Non-Rheumatic Valvular Heart Disease Lopes, Mariana Pezzute Rosa, Vitor Emer Egypto Palma, José Honório Vieira, Marcelo Luiz Campos Fernandes, Joao Ricardo Cordeiro de Santis, Antonio Spina, Guilherme Sobreira Fonseca, Rafael de Jesus de Sá Marchi, Mauricio F. Abizaid, Alexandre de Brito, Fábio Sândoli Tarasoutchi, Flavio Sampaio, Roney Orismar Ribeiro, Henrique Barbosa Front Cardiovasc Med Cardiovascular Medicine Background: Bioprosthetic heart valve has limited durability and lower long-term performance especially in rheumatic heart disease (RHD) patients that are often subject to multiple redo operations. Minimally invasive procedures, such as transcatheter valve-in-valve (ViV) implantation, may offer an attractive alternative, although data is lacking. The aim of this study was to evaluate the baseline characteristics and clinical outcomes in rheumatic vs. non-rheumatic patients undergoing ViV procedures for severe bioprosthetic valve dysfunction. Methods: Single center, prospective study, including consecutive patients undergoing transcatheter ViV implantation in aortic, mitral and tricuspid position, from May 2015 to September 2020. RHD was defined according to clinical history, previous echocardiographic and surgical findings. Results: Among 106 patients included, 69 had rheumatic etiology and 37 were non-rheumatic. Rheumatic patients had higher incidence of female sex (73.9 vs. 43.2%, respectively; p = 0.004), atrial fibrillation (82.6 vs. 45.9%, respectively; p < 0.001), and 2 or more prior surgeries (68.1 vs. 32.4%, respectively; p = 0.001). Although, device success was similar between groups (75.4 vs. 89.2% in rheumatic vs. non-rheumatic, respectively; p = 0.148), there was a trend toward higher 30-day mortality rates in the rheumatic patients (21.7 vs. 5.4%, respectively; p = 0.057). Still, at median follow-up of 20.7 [5.1–30.4] months, cumulative mortality was similar between both groups (p = 0.779). Conclusion: Transcatheter ViV implantation is an acceptable alternative to redo operations in the treatment of patients with RHD and severe bioprosthetic valve dysfunction. Despite similar device success rates, rheumatic patients present higher 30-day mortality rates with good mid-term clinical outcomes. Future studies with a larger number of patients and follow-up are still warranted, to firmly conclude on the role transcatheter ViV procedures in the RHD population. Frontiers Media S.A. 2021-08-04 /pmc/articles/PMC8373457/ /pubmed/34422923 http://dx.doi.org/10.3389/fcvm.2021.694339 Text en Copyright © 2021 Lopes, Rosa, Palma, Vieira, Fernandes, de Santis, Spina, Fonseca, de Sá Marchi, Abizaid, de Brito, Tarasoutchi, Sampaio and Ribeiro. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Cardiovascular Medicine
Lopes, Mariana Pezzute
Rosa, Vitor Emer Egypto
Palma, José Honório
Vieira, Marcelo Luiz Campos
Fernandes, Joao Ricardo Cordeiro
de Santis, Antonio
Spina, Guilherme Sobreira
Fonseca, Rafael de Jesus
de Sá Marchi, Mauricio F.
Abizaid, Alexandre
de Brito, Fábio Sândoli
Tarasoutchi, Flavio
Sampaio, Roney Orismar
Ribeiro, Henrique Barbosa
Transcatheter Valve-in-Valve Procedures for Bioprosthetic Valve Dysfunction in Patients With Rheumatic vs. Non-Rheumatic Valvular Heart Disease
title Transcatheter Valve-in-Valve Procedures for Bioprosthetic Valve Dysfunction in Patients With Rheumatic vs. Non-Rheumatic Valvular Heart Disease
title_full Transcatheter Valve-in-Valve Procedures for Bioprosthetic Valve Dysfunction in Patients With Rheumatic vs. Non-Rheumatic Valvular Heart Disease
title_fullStr Transcatheter Valve-in-Valve Procedures for Bioprosthetic Valve Dysfunction in Patients With Rheumatic vs. Non-Rheumatic Valvular Heart Disease
title_full_unstemmed Transcatheter Valve-in-Valve Procedures for Bioprosthetic Valve Dysfunction in Patients With Rheumatic vs. Non-Rheumatic Valvular Heart Disease
title_short Transcatheter Valve-in-Valve Procedures for Bioprosthetic Valve Dysfunction in Patients With Rheumatic vs. Non-Rheumatic Valvular Heart Disease
title_sort transcatheter valve-in-valve procedures for bioprosthetic valve dysfunction in patients with rheumatic vs. non-rheumatic valvular heart disease
topic Cardiovascular Medicine
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8373457/
https://www.ncbi.nlm.nih.gov/pubmed/34422923
http://dx.doi.org/10.3389/fcvm.2021.694339
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