Valve-in-Valve Implantation Using the ACURATE Neo in Degenerated Aortic Bioprostheses: An International Multicenter Analysis
Holzamer, Andreas; Kim, Won-Keun; Rück, Andreas; Sathananthan, Janarthanan; Keller, Lukas; Cosma, Joseph; Bauer, Timm; Nef, Holger; Amat-Santos, Ignacio J; Brinkert, Miriam; Husser, Oliver; Pellegrini, Costanza; Schofer, Joachim; Nerla, Roberto; Montorfano, Matteo; Giannini, Francesco; Stella, Pieter; Kuwata, Shingo; Hilker, Michael; Castriota, Fausto; Ussia, Gian Paolo; Webb, John G; Nietlispach, Fabian; Toggweiler, Stefan
(2019) JACC. Cardiovascular Interventions, volume 12, issue 22, pp. 2309 - 2316
(Article)
Abstract
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
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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.
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Keywords: AVA, aortic valve area, ID, inner diameter, PPM, prosthesis-patient mismatch, THV, transcatheter heart valve, ViV, valve-in-valve, transcatheter aortic valve implantation, transfemoral, transcatheter aortic valve replacement, valve-in-valve, degenerated bioprosthesis, Cardiology and Cardiovascular Medicine, Journal Article
ISSN: 1936-8798
Publisher: Elsevier
Note: Copyright © 2019 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
(Peer reviewed)