Impact of implant depth on hydrodynamic function of the ALLEGRA bioprosthesis in valve-in-valve interventions
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Impact of implant depth on hydrodynamic function of the ALLEGRA bioprosthesis in valve-in-valve interventions. / Sathananthan, Janarthanan; Fraser, Rob; Kütting, Maximilian; Hensey, Mark; Landes, Uri; Alkhodair, Abdullah; Sedaghat, Alexander; Blanke, Philipp; Toggweiler, Stefan; Leipsic, Jonathon; Søndergaard, Lars; Wood, David; Webb, John G.
I: EuroIntervention, Bind 15, Nr. 15, 2020, s. E1335-E1342.Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › fagfællebedømt
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TY - JOUR
T1 - Impact of implant depth on hydrodynamic function of the ALLEGRA bioprosthesis in valve-in-valve interventions
AU - Sathananthan, Janarthanan
AU - Fraser, Rob
AU - Kütting, Maximilian
AU - Hensey, Mark
AU - Landes, Uri
AU - Alkhodair, Abdullah
AU - Sedaghat, Alexander
AU - Blanke, Philipp
AU - Toggweiler, Stefan
AU - Leipsic, Jonathon
AU - Søndergaard, Lars
AU - Wood, David
AU - Webb, John G.
PY - 2020
Y1 - 2020
N2 - Aims: We aimed to assess the impact of implant depth on hydrodynamic function following valve-in-valve (VIV) intervention using the ALLEGRA transcatheter heart valve (THV) in three different surgical valve designs. Methods and results: Multiple implantation depths (+2 mm, -2 mm and -6 mm) were tested using a 23 mm ALLEGRA THV for VIV intervention in 19 mm, 21 mm, 23 mm, and 25 mm Epic, Mitroflow and Magna Ease bioprosthetic valves. Multimodality imaging and hydrodynamic evaluation was performed at each implantation depth. The 23 mm ALLEGRA valve had gradients <20 mmHg in the Mitroflow and Epic valves sized ≥21 mm, and in all sizes of the Magna Ease valve. Gradients did not increase significantly at lower implantation depths. The 19 mm Epic (+2 mm: 20.1±0.6 mmHg, -2 mm: 18.8±0.5 mmHg, -6 mm: 22.8±0.3 mmHg) and 19 mm Mitroflow (+2 mm: 24.1±0.2 mmHg, -2 mm: 31.5±0.3 mmHg, -6 mm: 25.6±0.2 mmHg) valves had elevated mean gradients. In larger sized surgical valves (≥23 mm) the regurgitant fraction was higher at low implantation depths. Pinwheeling was significantly worse in the smaller sized (≤21 mm) surgical valves and also at low (<-2 mm) implantation depth. Conclusions: The 23 mm ALLEGRA valve had favourable (<20 mmHg) gradients in all surgical valves sized ≥21 mm, even when the THV was implanted low. In 19 mm sized Mitroflow and Epic valves, gradients were elevated (>20 mmHg). While there was no major difference in mean transvalvular gradients, leaflet pinwheeling was worse at lower implantation depths.
AB - Aims: We aimed to assess the impact of implant depth on hydrodynamic function following valve-in-valve (VIV) intervention using the ALLEGRA transcatheter heart valve (THV) in three different surgical valve designs. Methods and results: Multiple implantation depths (+2 mm, -2 mm and -6 mm) were tested using a 23 mm ALLEGRA THV for VIV intervention in 19 mm, 21 mm, 23 mm, and 25 mm Epic, Mitroflow and Magna Ease bioprosthetic valves. Multimodality imaging and hydrodynamic evaluation was performed at each implantation depth. The 23 mm ALLEGRA valve had gradients <20 mmHg in the Mitroflow and Epic valves sized ≥21 mm, and in all sizes of the Magna Ease valve. Gradients did not increase significantly at lower implantation depths. The 19 mm Epic (+2 mm: 20.1±0.6 mmHg, -2 mm: 18.8±0.5 mmHg, -6 mm: 22.8±0.3 mmHg) and 19 mm Mitroflow (+2 mm: 24.1±0.2 mmHg, -2 mm: 31.5±0.3 mmHg, -6 mm: 25.6±0.2 mmHg) valves had elevated mean gradients. In larger sized surgical valves (≥23 mm) the regurgitant fraction was higher at low implantation depths. Pinwheeling was significantly worse in the smaller sized (≤21 mm) surgical valves and also at low (<-2 mm) implantation depth. Conclusions: The 23 mm ALLEGRA valve had favourable (<20 mmHg) gradients in all surgical valves sized ≥21 mm, even when the THV was implanted low. In 19 mm sized Mitroflow and Epic valves, gradients were elevated (>20 mmHg). While there was no major difference in mean transvalvular gradients, leaflet pinwheeling was worse at lower implantation depths.
KW - Aortic stenosis
KW - Degenerative valve
KW - Prior cardiovascular surgery
KW - TAVI
KW - Valve restenosis
KW - Valve-in-valve
U2 - 10.4244/EIJ-D-19-00782
DO - 10.4244/EIJ-D-19-00782
M3 - Journal article
C2 - 31607682
AN - SCOPUS:85083368172
VL - 15
SP - E1335-E1342
JO - EuroIntervention
JF - EuroIntervention
SN - 1774-024X
IS - 15
ER -
ID: 250168558