Transcatheter Aortic Valve-in-Valve Replacement for Degenerated Stentless Bioprosthetic Aortic Valves: Results of a Multicenter Retrospective Analysis
| Autor: | Matthew, Miller, Mandy, Snyder, Benjamin D, Horne, James R, Harkness, John R, Doty, Edward C, Miner, Kent W, Jones, Kelly R, O'Neal, Bruce B, Reid, William T, Caine, Stephen E, Clayson, Eric, Lindley, Blake, Gardner, Rafe C, Connors, B Jason, Bowles, Brian K, Whisenant |
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| Rok vydání: | 2019 |
| Předmět: |
Bioprosthesis
Heart Valve Prosthesis Implantation Male Time Factors Databases Factual Aortic Valve Insufficiency Myocardial Infarction Aortic Valve Stenosis Recovery of Function Middle Aged Prosthesis Design Risk Assessment United States Prosthesis Failure Transcatheter Aortic Valve Replacement Treatment Outcome Coronary Occlusion Risk Factors Aortic Valve Heart Valve Prosthesis Humans Female Aged Retrospective Studies |
| Zdroj: | JACC. Cardiovascular interventions. 12(13) |
| ISSN: | 1876-7605 |
| Popis: | The purpose of this study was to evaluate the safety and efficacy of valve-in-valve (ViV) transcatheter aortic valve replacement (TAVR) for stentless bioprosthetic aortic valves (SBAVs) and to identify predictors of adverse events.ViV TAVR in SBAVs is associated with unique technical challenges and risks.Clinical records and computer tomographic scans were retrospectively reviewed for procedural complications, predictors of coronary obstruction, mortality, and echocardiographic results.Among 66 SBAV patients undergoing ViV TAVR, mortality was 2 of 66 patients (3.0%) at 30 days and 5 of 52 patients (9.6%) at 1 year. At 1 year, left ventricular end-systolic dimension was decreased versus baseline (median [interquartile range (IQR)]: 3.0 [2.6 to 3.6] cm vs. 3.7 [3.2 to 4.4] cm; p 0.001). Coronary occlusion in 6 of 66 procedures (9.1%) resulted in myocardial infarction in 2 of 66 procedures (3.0%). Predictors of coronary occlusion included subcoronary implant technique compared with full root replacement (6 of 31, 19.4% vs. 0 of 28, 0%; p = 0.01), short simulated radial valve-to-coronary distance (median [IQR]: 3.4 [0.0 to 4.6] mm vs. 4.6 [3.2 to 6.2] mm; p = 0.016), and low coronary height (7.8 [5.8 to 10.0] mm vs. 11.6 [8.7 to 13.9] mm; p = 0.003). Coronary arteries originated 10 mm above the valve leaflets in 34 of 97 unobstructed coronary arteries (35.1%).TAVR in SBAVs is frequently associated with high-risk coronary anatomy but can be performed with a low risk of death and myocardial infarction, resulting in favorable ventricular remodeling. A subcoronary surgical approach is associated with an increased risk of coronary obstruction. |
| Databáze: | OpenAIRE |
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