Timing of bioprosthetic valve fracture in transcatheter valve-in-valve intervention: impact on valve durability and leaflet integrity
Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › fagfællebedømt
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Timing of bioprosthetic valve fracture in transcatheter valve-in-valve intervention : impact on valve durability and leaflet integrity. / Meier, David; Payne, Geoffrey W.; Mostaço-Guidolin, Leila B.; Bouchareb, Rihab; Rich, Courtney; Lai, Althea; Chatfield, Andrew G.; Akodad, Mariama; Salcudean, Hannah; Lutter, Georg; Puehler, Thomas; Pibarot, Philippe; Allen, Keith B.; Chhatriwalla, Adnan K.; Sondergaard, Lars; Wood, David A.; Webb, John G.; Leipsic, Jonathon A.; Sathananthan, Janarthanan; Sellers, Stephanie L.
I: EuroIntervention, Bind 18, Nr. 14, 2023, s. 1165-1177.Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › fagfællebedømt
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TY - JOUR
T1 - Timing of bioprosthetic valve fracture in transcatheter valve-in-valve intervention
T2 - impact on valve durability and leaflet integrity
AU - Meier, David
AU - Payne, Geoffrey W.
AU - Mostaço-Guidolin, Leila B.
AU - Bouchareb, Rihab
AU - Rich, Courtney
AU - Lai, Althea
AU - Chatfield, Andrew G.
AU - Akodad, Mariama
AU - Salcudean, Hannah
AU - Lutter, Georg
AU - Puehler, Thomas
AU - Pibarot, Philippe
AU - Allen, Keith B.
AU - Chhatriwalla, Adnan K.
AU - Sondergaard, Lars
AU - Wood, David A.
AU - Webb, John G.
AU - Leipsic, Jonathon A.
AU - Sathananthan, Janarthanan
AU - Sellers, Stephanie L.
PY - 2023
Y1 - 2023
N2 - BACKGROUND: Bioprosthetic valve fracture (BVF) can be used to improve transcatheter heart valve (THV) haemodynamics following a valve-in-valve (ViV) intervention. However, whether BVF should be performed before or after THV deployment and the implications on durability are unknown. Aims: We sought to assess the impact of BVF timing on long-term THV durability. METHODS: The impact of BVF timing was assessed using small ACURATE neo (ACn) or 23 mm SAPIEN 3 (S3) THV deployed in 21 mm Mitroflow valves compared to no-BVF controls. Valves underwent accelerated wear testing up to 200 million (M) cycles (equivalent to 5 years). At 200M cycles, THV were evaluated by hydrodynamic testing, second-harmonic generation (SHG) microscopy, scanning electron microscopy (SEM) and histology. RESULTS: At 200M cycles, the regurgitant fraction (RF) and effective orifice area (EOA) for the ACn were 8.03±0.30%/1.74±0.01 cm2 (no BVF), 12.48±0.70%/1.97±0.02 cm2 (BVF before ViV) and 9.29±0.38%/2.21±0.0 cm2 (BVF after ViV), respectively. For the S3 these values were 2.63±0.51%/1.26±0.01 cm2, 2.03±0.42%/1.65±0.01 cm2, and 1.62±0.38%/2.22±0.01 cm2, respectively. Further, SHG and SEM revealed a higher degree of superficial leaflet damage when BVF was performed after ViV for the ACn and S3. However, the histological analysis revealed significantly less damage, as determined by matrix density analysis, through the entire leaflet thickness when BVF was performed after ViV with the S3 and a similar but non-significant trend with the ACn. Conclusions: BVF performed after ViV appears to offer superior long-term EOA without increased RF. Ultrastructure leaflet analysis reveals that the timing of BVF can differentially impact leaflets, with more superficial damage but greater preservation of overall leaflet structure when BVF is performed after ViV.
AB - BACKGROUND: Bioprosthetic valve fracture (BVF) can be used to improve transcatheter heart valve (THV) haemodynamics following a valve-in-valve (ViV) intervention. However, whether BVF should be performed before or after THV deployment and the implications on durability are unknown. Aims: We sought to assess the impact of BVF timing on long-term THV durability. METHODS: The impact of BVF timing was assessed using small ACURATE neo (ACn) or 23 mm SAPIEN 3 (S3) THV deployed in 21 mm Mitroflow valves compared to no-BVF controls. Valves underwent accelerated wear testing up to 200 million (M) cycles (equivalent to 5 years). At 200M cycles, THV were evaluated by hydrodynamic testing, second-harmonic generation (SHG) microscopy, scanning electron microscopy (SEM) and histology. RESULTS: At 200M cycles, the regurgitant fraction (RF) and effective orifice area (EOA) for the ACn were 8.03±0.30%/1.74±0.01 cm2 (no BVF), 12.48±0.70%/1.97±0.02 cm2 (BVF before ViV) and 9.29±0.38%/2.21±0.0 cm2 (BVF after ViV), respectively. For the S3 these values were 2.63±0.51%/1.26±0.01 cm2, 2.03±0.42%/1.65±0.01 cm2, and 1.62±0.38%/2.22±0.01 cm2, respectively. Further, SHG and SEM revealed a higher degree of superficial leaflet damage when BVF was performed after ViV for the ACn and S3. However, the histological analysis revealed significantly less damage, as determined by matrix density analysis, through the entire leaflet thickness when BVF was performed after ViV with the S3 and a similar but non-significant trend with the ACn. Conclusions: BVF performed after ViV appears to offer superior long-term EOA without increased RF. Ultrastructure leaflet analysis reveals that the timing of BVF can differentially impact leaflets, with more superficial damage but greater preservation of overall leaflet structure when BVF is performed after ViV.
U2 - 10.4244/EIJ-D-22-00644
DO - 10.4244/EIJ-D-22-00644
M3 - Journal article
C2 - 36534495
AN - SCOPUS:85149168354
VL - 18
SP - 1165
EP - 1177
JO - EuroIntervention
JF - EuroIntervention
SN - 1774-024X
IS - 14
ER -
ID: 347690384