Abstract 16199: Hemodynamic Effect of CoreValve Size and Position for Valve-in-valve Implantation in Small Surgical Bioprostheses: An in vitro Study
Introduction: Valve-in-Valve (ViV) has emerged as a valuable alternative to treat failed surgical bioprostheses (BP) in patients at high surgical-risk. However, this procedure is often associated with elevated post-procedural gradients especially in small BPs. The objective of this study was to 1) assess the effect of ViV procedure with the self-expending CoreValve (CV) in several models and sizes of surgical BPs, 2) compare different ViV assemblies in order to guide clinicians for the ViV implantation.
Method: The CV was implanted in 2 models of BP: the pericardial Trifecta (TF) and the porcine Epic Supra (ESP). The 23 mm CV was implanted in BPs size 19 and 21 mm and CV 26 in BP 21 mm only. For each CV-BP combination, the CV was implanted in 3 longitudinal positions: i) intra-annular (AA, 2 struts of the CV stent below the BP sewing ring), ii) supra-annular (SAA) and iii) high supra-annular position (HSAA). A pulsed duplicator was used to generate various flow conditions. Mean transvalvular pressure gradients (TPG) were assessed by Doppler-echocardiography and flowmeter.
Results: Before ViV, TPGs were substantially lower through TF than through ESP. ViV resulted in a TPG increase with the TF but not with the ESP (fig). In TF ViV, the magnitude of TPG increase was found lower with higher CV position. In ESP ViV, hemodynamics was even improved for the HSAA position, ie decrease in TPGs. The magnitude of TPG reductions between pre and post VinV was more important with the larger CV (CV 23: preVinV 17±8 vs. post 12±5 mmHg; CV 26: pre 17±8 vs. post 8±4). The HSAA was however associated with migration of the valve within the ESP.
Conclusion: This study shows that supra-annular positioning of the CV is associated with better hemodynamics for ViV. Moderate oversizing and high supra-annular positioning of the CV allow to minimize the increase in TPG associated with ViV within small surgical BPs. The HSAA may however be associated with risk of CV dislodgment and embolization in some models of BPs such as the ESP.
- Aortic valve
- Transcatheter aortic valve implantation
- Prosthetic valves
- Percutaneous non-coronary cardiac intervention
- Valvular disease
Author Disclosures: A. Zenses: None. V. Stanova: None. M. Evin: None. J. Obadia: None. J. Rodés-Cabau: Research Grant; Significant; Edwards Lifesciences, Medtronic. P. Pibarot: Research Grant; Significant; Edwards Lifesciences, Medtronic. R. Rieu: None.
- © 2016 by American Heart Association, Inc.