Matched comparison of next- and early-generation balloon-expandable transcatheter hear valve implantations in failed surgical aortic bioprostheses

作者：Seiffert Moritz; Treede Hendrik; Schofer Joachim; Linke Axel; Woehrle Jochen; Baumbach Hardy; Mehilli Julinda; Bapat Vinayak; Simonato Matheus; Walther Thomas; Kullmer Mathias; Boekstegers Peter; Ensminger Stephan; Kurz Thomas; Eltchaninoff Helene; Rastan Ardawan; Werner Nicolas; de Weger Arend; Frerker Christian; Lauer Bernward; Muller Olivier; Whisenant Brian; Thukkani Arun; Weisz Giora; Dvir Danny^*

来源：Eurointervention, 2018, 14(4): E397-E404.

DOI：10.4244/EIJ-D-17-00546

• aortic regurgitation
• aortic stenosis
• degenerative valve
• TAVI
• valve-in-valve

Aims: Transcatheter valve-in-valve implantation (VinV) is established for the treatment of degenerated surgical bioprostheses in patients at high operative risk. Our aim was to report on the first large assessment of VinV with next-generation balloon-expandable transcatheter heart valves.
Methods and results: After SAPIEN XT or SAPIEN 3 VinV, 514 patients were analysed using an inverse probability of treatment weighting. Standardised clinical and haemodynamic outcomes were compared, and core laboratory evaluation of implantation depth was performed. Thirty-day all-cause mortality was 0.6% and 3.5% for SAPIEN 3 and SAPIEN XT (p=0.077). Residual transprosthetic gradient >= 20 mmHg was observed in 38.3% (SAPIEN 3) and 35.7% (SAPIEN XT) of patients (p=0.627) with increased rates in small bioprostheses (1 mm true ID). In SAPIEN 3 VinV, low implantation depth >20% THV stent frame length was associated with a higher rate of elevated transaortic gradients (p=0.048). Similarly, an implantation depth >5 mm was linked to more pacemaker implantations (p=0.01). Overall, a trend towards higher pacemaker implantation rates was observed alter SAPIEN 3 VinV (6% vs. 2.5% in SAPIEN XT, 0.071).
Conclusions: Transcatheter aortic VinV with the balloon-expandable SAPIEN XT or SAPIEN 3 was similarly safe and effective. However, residual stenosis remains a concern, particularly in smaller bioprostheses and with increasing implantation depth.

• 出版日期2018-7