Matched Comparison of Self-Expanding Transcatheter Heart Valves for the Treatment of Failed Aortic Surgical Bioprosthesis

S. Alnasser, A.N. Cheema, M. Simonato, M. Barbanti, J. Edwards, R. Kornowski, E. Horlick, H.C. Wijeysundera, L. Testa, F. Bedogni, H. Amrane, T. Walther, M. Pelletier, A. Latib, J.-C. Laborde, D. Hildick-Smith, W.-K. Kim, D. Tchetche, M. Agrifoglio, J.-M. SinningA.J. Van Boven, J. Kefer, C. Frerker, N.M. Van Mieghem, A. Linke, S. Worthley, A. Asgar, C. Sgroi, M. Aziz, H.D. Danenberg, M. Labinaz, G. Manoharan, A. Cheung, J.G. Webb, D. Dvir

Research output: Contribution to journalArticlepeer-review

Abstract

Background - Transcatheter valve-in-valve implantation is an established therapy for high-risk patients with failed surgical aortic bioprosthesis. There are limited data comparing outcomes of valve-in-valve implantation using different transcatheter heart valves (THV). Methods and Results - Patients included in the Valve-in-Valve International Data registry (VIVID) and treated with self-expanding THV devices were analyzed using centralized core laboratory blinded to clinical events. St. Jude Medical Portico versus Medtronic CoreValve were compared in a 1:2 fashion after propensity score matching. A total of 162 patients, Portico- (n=54) and CoreValve- (n=108) based valve-in-valve procedures comprised the study population with no significant difference in baseline characteristics (age, 79±8.2 years; 60% women; mean STS [Society of Thoracic Surgery] score 8.1±5.5%). Postimplantation, CoreValve was associated with a larger effective orifice area (1.67 versus 1.31 cm 2; P=0.001), lower mean gradient (14±7.5 versus 17±7.5 mm Hg; P=0.02), and lower core laboratory-adjudicated moderate-to-severe aortic insufficiency (4.2% versus 13.7%; P=0.04), compared with Portico. Procedural complications including THV malpositioning, second THV requirement, or coronary obstruction were not significantly different between the 2 groups. Survival and stroke rates at 30 days were similar, but overall mortality at 1 year was higher among patients treated with Portico compared with CoreValve (22.6% versus 9.1%; P=0.03). Conclusions - In this first matched comparison of THVs for valve-in-valve implantations, Portico and CoreValve demonstrated differences in postprocedural hemodynamics and long-term clinical outcomes. Although this could be related to THV design characteristics, the impact of other procedural factors cannot be excluded and require further evaluation. © 2017 American Heart Association, Inc.
Original languageEnglish
JournalCirculation: Cardiovascular Interventions
Volume10
Issue number4
DOIs
Publication statusPublished - 2017

Keywords

  • aortic valve
  • bioprosthesis
  • hemodynamic
  • transcatheter aortic valve replacement
  • acute kidney failure
  • aged
  • aorta valve regurgitation
  • Article
  • brain hemorrhage
  • brain ischemia
  • clinical outcome
  • comparative study
  • core laboratory
  • coronary artery obstruction
  • female
  • heart block
  • heart hemodynamics
  • human
  • major clinical study
  • male
  • malignant neoplasm
  • mortality rate
  • percutaneous aortic valve
  • perforation
  • pneumonia
  • post treatment survival
  • priority journal
  • prosthesis dislocation
  • reoperation
  • self expanding transcatheter heart valve
  • transcatheter aortic valve implantation
  • adverse effects
  • aortic valve stenosis
  • clinical trial
  • epidemiology
  • Europe
  • follow up
  • heart valve prosthesis
  • hemodynamics
  • Middle East
  • mortality
  • multicenter study
  • New Zealand
  • pathophysiology
  • procedures
  • propensity score
  • prospective study
  • prosthesis design
  • register
  • survival rate
  • treatment outcome
  • trends
  • United States
  • Aged
  • Aortic Valve
  • Aortic Valve Stenosis
  • Bioprosthesis
  • Female
  • Follow-Up Studies
  • Heart Valve Prosthesis
  • Hemodynamics
  • Humans
  • Male
  • Propensity Score
  • Prospective Studies
  • Prosthesis Design
  • Registries
  • Reoperation
  • Survival Rate
  • Transcatheter Aortic Valve Replacement
  • Treatment Outcome

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