Valve-in-Valve Implantation Using the ACURATE Neo in Degenerated Aortic Bioprostheses: An International Multicenter Analysis.

Autor:	Holzamer A; Department of Cardiothoracic Surgery, University of Regensburg Medical Center, Regensburg, Germany., Kim WK; Department of Cardiology and Cardiac Surgery, Kerckhoff Heart and Lung Center, Bad Nauheim, Germany., Rück A; Department of Medicine, Unit of Cardiology, Karolinska University Hospital, Stockholm, Sweden., Sathananthan J; Centre for Heart Valve Innovation, St. Paul's and Vancouver General Hospitals, University of British Columbia, Vancouver, Canada., Keller L; Department of Cardiology, University Hospital Zürich, Zurich, Switzerland., Cosma J; Department of Cardiology, University Campus Bio/Medico, University of Rome Tor Vergata, Rome, Italy., Bauer T; Department of Cardiology, University Hospital Giessen, Giessen, Germany., Nef H; Department of Cardiology, University Hospital Giessen, Giessen, Germany., Amat-Santos IJ; Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares, Department of Cardiology, Hospital Universitario de Valladolid, Valladolid, Spain., Brinkert M; Division of Cardiology, Heart Center Lucerne, Luzerner Kantonsspital, Lucerne, Switzerland., Husser O; Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Munich, Germany., Pellegrini C; Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Munich, Germany., Schofer J; Albertinen Herzzentrum und Medizinisches Versorgungszentrum Prof. Dr. Mathey, Hamburg, Germany., Nerla R; Cardiovascular Department, Humanitas Gavazzeni, Bergmo, Italy., Montorfano M; Interventional Cardiology Unit, San Raffaele Institute, Milan, Italy., Giannini F; Interventional Cardiology Unit, San Raffaele Institute, Milan, Italy., Stella P; Department of Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands., Kuwata S; Department of Cardiology, University Hospital Zürich, Zurich, Switzerland., Hilker M; Department of Cardiothoracic Surgery, University of Regensburg Medical Center, Regensburg, Germany., Castriota F; Cardiovascular Department, Humanitas Gavazzeni, Bergmo, Italy., Ussia GP; Department of Cardiology, University Campus Bio/Medico, University of Rome Tor Vergata, Rome, Italy., Webb JG; Centre for Heart Valve Innovation, St. Paul's and Vancouver General Hospitals, University of British Columbia, Vancouver, Canada., Nietlispach F; Department of Cardiology, University Hospital Zürich, Zurich, Switzerland., Toggweiler S; Division of Cardiology, Heart Center Lucerne, Luzerner Kantonsspital, Lucerne, Switzerland. Electronic address: stefan.toggweiler@luks.ch.
Jazyk:	angličtina
Zdroj:	JACC. Cardiovascular interventions [JACC Cardiovasc Interv] 2019 Nov 25; Vol. 12 (22), pp. 2309-2316.
DOI:	10.1016/j.jcin.2019.07.042
Abstrakt:	Objectives: This study reports an international experience using the transfemoral ACURATE neo transcatheter heart valve (Boston Scientific, Marlborough, Massachusetts) for the treatment of degenerated surgical aortic bioprostheses. Background: Transcatheter valve-in-valve procedures have emerged as an alternative to redo surgery. Supra-annular prostheses might be particularly useful in this indication. Methods: This is an international multicenter analysis including 85 patients from 14 centers in Europe and Canada undergoing an ACURATE neo valve-in-valve procedure from March 2015 to February 2019. Results: Internal diameter of the degenerated bioprosthesis was 20.3 ± 2.1 mm. Prosthesis size S was used in 70 (82%) procedures. The median depth of implantation was 3 mm and the upper crown of the ACURATE neo was positioned above the stent posts of the degenerated bioprosthesis in 54 (64%) and inside in 31 (36%). Mean transvalvular gradient before discharge was significantly lower if the upper crown was above the degenerated bioprosthesis (13.7 ± 5.9 mm Hg vs. 19.5 ± 10.0 mm Hg; p = 0.001). However, a high position of the ACURATE neo resulted in embolization in 1 patient, conversion to open-heart surgery in 1, and need for reintervention due to transcatheter heart valve failure within the first 18 months of follow-up in 4. Conclusions: This early experience shows that a high implantation of the ACURATE neo with the upper crown above the stent posts of the degenerated bioprosthesis resulted in lower mean transvalvular gradients but a higher rate of malpositioning and early valve degeneration. (Copyright © 2019 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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