Bioprosthetic valve fracture

Technical insights from a multicenter study

Bioprosthetic Valve Fracture Investigators

Research output: Contribution to journalArticle

Abstract

Objective: Valve-in-valve transcatheter aortic valve replacement (VIV TAVR) can result in high residual gradients that are associated with increased mortality. Bioprosthetic valve fracture (BVF) has been shown to improve residual gradients following VIV TAVR; however, factors influencing the results of BVF have not been studied. Methods: BVF was performed in 75 patients at 21 centers. Hierarchical multiple linear regression was performed to identify variables that were associated with lower final transvalvular gradient. Results: Surgical valves with a median true internal diameter of 18.5 mm (interquartile range, 17.0-20.5 mm) were treated with VIV TAVR in conjunction with BVF using balloon-expandable (n = 43) or self-expanding (n = 32) transcatheter heart valves with a median size of 23 mm (interquartile range, 23-23 mm). There were no aortic root disruptions, coronary occlusions, or new pacemakers; in-hospital or 30-day mortality was 2.6% (2 out of 75). Final mean transvalvular gradient was 9.2 ± 6.3 mm Hg, but was significantly lower when BVF was performed after VIV TAVR compared with BVF first (8.1 ± 4.8 mm Hg vs 16.9 ± 10.1 mm Hg; P <.001). After adjusting for timing of BVF (ie, before or after VIV TAVR), transcatheter heart valve size/type, surgical valve mode of failure, true internal diameter, and baseline gradient and BVF balloon size, performing BVF after VIV TAVR (P <.001) and using a larger BVF balloon (P =.038) were the only independent predictors of lower final mean gradient. Conclusions: BVF can be performed safely and results in reduced residual transvalvular gradients. Performing BVF after VIV TAVR and using larger balloon appears to achieve the best hemodynamic results.

Original languageEnglish (US)
JournalJournal of Thoracic and Cardiovascular Surgery
DOIs
StatePublished - Jan 1 2019

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Multicenter Studies
Heart Valves
Surgical Instruments
Mortality
Coronary Occlusion
Transcatheter Aortic Valve Replacement
Linear Models
Hemodynamics

Keywords

  • bioprosthetic valve fracture (BVF)
  • valve in valve transcatheter aortic valve replacement (VIV TAVR)

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Bioprosthetic valve fracture : Technical insights from a multicenter study. / Bioprosthetic Valve Fracture Investigators.

In: Journal of Thoracic and Cardiovascular Surgery, 01.01.2019.

Research output: Contribution to journalArticle

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title = "Bioprosthetic valve fracture: Technical insights from a multicenter study",
abstract = "Objective: Valve-in-valve transcatheter aortic valve replacement (VIV TAVR) can result in high residual gradients that are associated with increased mortality. Bioprosthetic valve fracture (BVF) has been shown to improve residual gradients following VIV TAVR; however, factors influencing the results of BVF have not been studied. Methods: BVF was performed in 75 patients at 21 centers. Hierarchical multiple linear regression was performed to identify variables that were associated with lower final transvalvular gradient. Results: Surgical valves with a median true internal diameter of 18.5 mm (interquartile range, 17.0-20.5 mm) were treated with VIV TAVR in conjunction with BVF using balloon-expandable (n = 43) or self-expanding (n = 32) transcatheter heart valves with a median size of 23 mm (interquartile range, 23-23 mm). There were no aortic root disruptions, coronary occlusions, or new pacemakers; in-hospital or 30-day mortality was 2.6{\%} (2 out of 75). Final mean transvalvular gradient was 9.2 ± 6.3 mm Hg, but was significantly lower when BVF was performed after VIV TAVR compared with BVF first (8.1 ± 4.8 mm Hg vs 16.9 ± 10.1 mm Hg; P <.001). After adjusting for timing of BVF (ie, before or after VIV TAVR), transcatheter heart valve size/type, surgical valve mode of failure, true internal diameter, and baseline gradient and BVF balloon size, performing BVF after VIV TAVR (P <.001) and using a larger BVF balloon (P =.038) were the only independent predictors of lower final mean gradient. Conclusions: BVF can be performed safely and results in reduced residual transvalvular gradients. Performing BVF after VIV TAVR and using larger balloon appears to achieve the best hemodynamic results.",
keywords = "bioprosthetic valve fracture (BVF), valve in valve transcatheter aortic valve replacement (VIV TAVR)",
author = "{Bioprosthetic Valve Fracture Investigators} and Allen, {Keith B.} and Chhatriwalla, {Adnan K.} and Saxon, {John T.} and Cohen, {David J.} and Nguyen, {Tom C.} and John Webb and Pranav Loyalka and Bavry, {Anthony A.} and Rovin, {Joshua D.} and Brian Whisenant and Danny Dvir and Kennedy, {Kevin F.} and Vinod Thourani and Richard Lee and Richard Lee and Suzanne Baron and Anthony Hart and Davis, {J. Russell} and Borkon, {A. Michael} and Sathananthan Janarthanan and Thomas Beaver and Ashkan Karimi and Dennis Gory and Lang Lin and Douglas Spriggs and John Ofenloch and Abhijeet Dhoble and Brian Hummel and Mark Russo and Bruce Haik and Michael Lim and Vasilis Babaliaros and Adam Greenbaum and William O'Neill and Juhana Karha and Park, {D. W.} and Ed Garrett and Alex Pak and Zafir Hawa and James Mitchell and Axel Unbehaun and Anwar Tandar and Pradeep Yadav and Jason Ricci and Alan Yeung",
year = "2019",
month = "1",
day = "1",
doi = "10.1016/j.jtcvs.2019.01.073",
language = "English (US)",
journal = "Journal of Thoracic and Cardiovascular Surgery",
issn = "0022-5223",
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TY - JOUR

T1 - Bioprosthetic valve fracture

T2 - Technical insights from a multicenter study

AU - Bioprosthetic Valve Fracture Investigators

AU - Allen, Keith B.

AU - Chhatriwalla, Adnan K.

AU - Saxon, John T.

AU - Cohen, David J.

AU - Nguyen, Tom C.

AU - Webb, John

AU - Loyalka, Pranav

AU - Bavry, Anthony A.

AU - Rovin, Joshua D.

AU - Whisenant, Brian

AU - Dvir, Danny

AU - Kennedy, Kevin F.

AU - Thourani, Vinod

AU - Lee, Richard

AU - Lee, Richard

AU - Baron, Suzanne

AU - Hart, Anthony

AU - Davis, J. Russell

AU - Borkon, A. Michael

AU - Janarthanan, Sathananthan

AU - Beaver, Thomas

AU - Karimi, Ashkan

AU - Gory, Dennis

AU - Lin, Lang

AU - Spriggs, Douglas

AU - Ofenloch, John

AU - Dhoble, Abhijeet

AU - Hummel, Brian

AU - Russo, Mark

AU - Haik, Bruce

AU - Lim, Michael

AU - Babaliaros, Vasilis

AU - Greenbaum, Adam

AU - O'Neill, William

AU - Karha, Juhana

AU - Park, D. W.

AU - Garrett, Ed

AU - Pak, Alex

AU - Hawa, Zafir

AU - Mitchell, James

AU - Unbehaun, Axel

AU - Tandar, Anwar

AU - Yadav, Pradeep

AU - Ricci, Jason

AU - Yeung, Alan

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Objective: Valve-in-valve transcatheter aortic valve replacement (VIV TAVR) can result in high residual gradients that are associated with increased mortality. Bioprosthetic valve fracture (BVF) has been shown to improve residual gradients following VIV TAVR; however, factors influencing the results of BVF have not been studied. Methods: BVF was performed in 75 patients at 21 centers. Hierarchical multiple linear regression was performed to identify variables that were associated with lower final transvalvular gradient. Results: Surgical valves with a median true internal diameter of 18.5 mm (interquartile range, 17.0-20.5 mm) were treated with VIV TAVR in conjunction with BVF using balloon-expandable (n = 43) or self-expanding (n = 32) transcatheter heart valves with a median size of 23 mm (interquartile range, 23-23 mm). There were no aortic root disruptions, coronary occlusions, or new pacemakers; in-hospital or 30-day mortality was 2.6% (2 out of 75). Final mean transvalvular gradient was 9.2 ± 6.3 mm Hg, but was significantly lower when BVF was performed after VIV TAVR compared with BVF first (8.1 ± 4.8 mm Hg vs 16.9 ± 10.1 mm Hg; P <.001). After adjusting for timing of BVF (ie, before or after VIV TAVR), transcatheter heart valve size/type, surgical valve mode of failure, true internal diameter, and baseline gradient and BVF balloon size, performing BVF after VIV TAVR (P <.001) and using a larger BVF balloon (P =.038) were the only independent predictors of lower final mean gradient. Conclusions: BVF can be performed safely and results in reduced residual transvalvular gradients. Performing BVF after VIV TAVR and using larger balloon appears to achieve the best hemodynamic results.

AB - Objective: Valve-in-valve transcatheter aortic valve replacement (VIV TAVR) can result in high residual gradients that are associated with increased mortality. Bioprosthetic valve fracture (BVF) has been shown to improve residual gradients following VIV TAVR; however, factors influencing the results of BVF have not been studied. Methods: BVF was performed in 75 patients at 21 centers. Hierarchical multiple linear regression was performed to identify variables that were associated with lower final transvalvular gradient. Results: Surgical valves with a median true internal diameter of 18.5 mm (interquartile range, 17.0-20.5 mm) were treated with VIV TAVR in conjunction with BVF using balloon-expandable (n = 43) or self-expanding (n = 32) transcatheter heart valves with a median size of 23 mm (interquartile range, 23-23 mm). There were no aortic root disruptions, coronary occlusions, or new pacemakers; in-hospital or 30-day mortality was 2.6% (2 out of 75). Final mean transvalvular gradient was 9.2 ± 6.3 mm Hg, but was significantly lower when BVF was performed after VIV TAVR compared with BVF first (8.1 ± 4.8 mm Hg vs 16.9 ± 10.1 mm Hg; P <.001). After adjusting for timing of BVF (ie, before or after VIV TAVR), transcatheter heart valve size/type, surgical valve mode of failure, true internal diameter, and baseline gradient and BVF balloon size, performing BVF after VIV TAVR (P <.001) and using a larger BVF balloon (P =.038) were the only independent predictors of lower final mean gradient. Conclusions: BVF can be performed safely and results in reduced residual transvalvular gradients. Performing BVF after VIV TAVR and using larger balloon appears to achieve the best hemodynamic results.

KW - bioprosthetic valve fracture (BVF)

KW - valve in valve transcatheter aortic valve replacement (VIV TAVR)

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DO - 10.1016/j.jtcvs.2019.01.073

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SN - 0022-5223

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