Impact of Different Valve-in-Valve Positions on Functional Results of the New Generation of Balloon-Expandable Transcatheter Heart Valve

Abstract

Objectives Very precise positioning of the transcatheter heart valve (THV) inside the degenerated SAV is a crucial factor for valve-in-valve (ViV) procedure to achieve optimal hemodynamic results. Therefore, our study aimed to investigate the impact of implantation depth on functional results after ViV procedures in a standardized in vitro setting.

Methods THV (SAPIEN 3 Ultra 23-mm size) and three SAV models (Magna Ease, Trifecta, and Hancock II—all 21-mm size) were tested at different circulatory conditions in five different positions of the THV (2–6 mm) inside the SAV. Mean pressure gradient (MPG), effective orifice area (EOA), geometric orifice area (GOA_max), and pinwheeling index (PWI_mean) were analyzed.

Results EOA and MPG of the THV did not differ significantly regarding the position inside the Magna Ease and the Hancock II (p > 0.05). However, EOA differed significantly, depending on the position of the THV inside Trifecta (2 vs. 5 mm; p = 0.021 and 2 vs. 6 mm; p < 0.001). The THV presented the highest EOA (2.047 cm²) and the lowest MPG (5.387 mm Hg) inside the Magna Ease, whereas the lowest EOA (1.335 cm²) and the highest MPG (11.876 mm Hg) were shown inside the Hancock II. Additionally, the highest GOA_max and the lowest PWI_mean of the THV were noticed inside the Magna Ease. The THV showed lower GOA_max and higher PWI_mean inside the Trifecta when placed in a deeper position.

Conclusion Deep implantation of the SAPIEN 3 Ultra inside the Trifecta correlates with impaired functional results. In contrast, the implantation position of the SAPIEN 3 Ultra inside the Magna Ease and the Hancock II did not have a significant effect on functional results.

Keywords

aortic valve - TAVI - valve in valve - implantation depth - SAPIEN 3 Ultra - bioprosthetic heart valve

Note

Data presented at the 37^th Annual Meeting and Scientific Sessions of the European Association for Cardio-Thoracic-Surgery, held on October 4–7, 2023, in Vienna, Austria.

Data Availability Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.

Publikationsverlauf

Eingereicht: 22. März 2024

Angenommen: 21. Mai 2024

Artikel online veröffentlicht:
18. Juni 2024

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