Current generation balloon-expandable transcatheter valve positioning strategies during aortic valve-in-valve procedures and clinical outcomes
JACC cardiovasc. interv
; 12(16): 1606-1617, ago., 2019. ilus., graf., tab.
Article
em En
| SES-SP, SESSP-IDPCPROD, SES-SP
| ID: biblio-1022472
Biblioteca responsável:
BR79.1
Localização: BR79.1
ABSTRACT
OBJECTIVES:
This study sought to evaluate SAPIEN 3 (S3) (Edwards Lifesciences, Irvine, California) positioning using different strategies.BACKGROUND:
Aortic valve-in-valve (ViV) is associated with high risk of elevated gradients.METHODS:
S3 aortic ViV procedures in stented bioprostheses were studied. Transcatheter heart valve (THV) positioning was analyzed in a centralized core lab blinded to clinical outcomes. A combined endpoint of severely elevated mean gradient ($30 mm Hg) or pacemaker need was established. Two positioning strategies were compared central marker method and top of S3 method. Optimal final depth was defined as S3 depth #20%.RESULTS:
A total of 113 patients met inclusion criteria and were analyzed (76.5 _ 9.7 years of age, 65.8% male, STS score 8 _ 7.6%). THVs had incomplete shortening in comparison to fully expanded valves (92 _ 3.4%), and expansion was more complete in optimal positioning cases compared with others (93.2 _ 2.7% vs. 91.5 _ 3.5%; p » 0.027). The central marker method demonstrated greater correlation with final implantation depth than the top of S3 method (R2 of 0.48 and 0.14; p < 0.001 and p » 0.001, respectively). The combined endpoint rate was 4.3% in the optimal (higher than 3 mm) implantation group, 12% in the intermediate group, and 50% in the low group (p < 0.001). There were no cases of THV embolization. In cases with central marker higher than 3 mm, 72.4% had optimal final depth. In those with central marker higher than 6 mm, 90% had optimal final depth.CONCLUSIONS:
Optimal S3 positioning in aortic ViV is associated with better outcomes. Central marker positioning is more reliable than top of S3 positioning. Central marker bottom position should be 3 mm to 6 mm above the ring. (AU)
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Bases de dados:
CONASS
/
SES-SP
Assunto principal:
Marca-Passo Artificial
/
Substituição da Valva Aórtica Transcateter
Idioma:
En
Revista:
JACC cardiovasc. interv
Ano de publicação:
2019
Tipo de documento:
Article