Clinical and Hemodynamic Outcomes of Balloon-Expandable Mitral Valve-in-Valve Positioning and Asymmetric Deployment: The VIVID Registry
Recommended Citation
Simonato M, Whisenant BK, Unbehaun A, Kempfert J, Ribeiro HB, Kornowski R, Erlebach M, Bleiziffer S, Windecker S, Pilgrim T, Tomii D, Guerrero M, Ahmad Y, Forrest JK, Montorfano M, Ancona M, Adam M, Wienemann H, Finkelstein A, Villablanca P, Codner P, Hildick-Smith D, Ferrari E, Petronio AS, Shamekhi J, Presbitero P, Bruschi G, Rudolph T, Cerillo A, Attias D, Nejjari M, Abizaid A, Felippi de Sá Marchi M, Horlick E, Wijeysundera H, Andreas M, Thukkani A, Agrifoglio M, Iadanza A, Baer LM, Nanna MG, and Dvir D. Clinical and Hemodynamic Outcomes of Balloon-Expandable Mitral Valve-in-Valve Positioning and Asymmetric Deployment: The VIVID Registry. JACC Cardiovasc Interv 2023; 16(21):2615-2627.
Document Type
Article
Publication Date
11-13-2023
Publication Title
JACC Cardiovasc Interv
Abstract
BACKGROUND: Mitral valve-in-valve (ViV) is associated with suboptimal hemodynamics and rare left ventricular outflow tract (LVOT) obstruction.
OBJECTIVES: This study aimed to determine whether device position and asymmetry are associated with these outcomes.
METHODS: Patients undergoing SAPIEN 3 (Edwards Lifesciences) mitral ViV included in the VIVID (Valve-in-Valve International Data) Registry were studied. Clinical endpoints are reported according to Mitral Valve Academic Research Consortium definitions. Residual mitral valve stenosis was defined as mean gradient ≥5 mm Hg. Depth of implantation (percentage of transcatheter heart valve [THV] atrial to the bioprosthesis ring) and asymmetry (ratio of 2 measures of THV height) were evaluated.
RESULTS: A total of 222 patients meeting the criteria for optimal core lab evaluation were studied (age 74 ± 11.6 years; 61.9% female; STS score = 8.3 ± 7.1). Mean asymmetry was 6.2% ± 4.4%. Mean depth of implantation was 19.0% ± 10.3% atrial. Residual stenosis was common (50%; mean gradient 5.0 ± 2.6 mm Hg). LVOT obstruction occurred in 7 cases (3.2%). Implantation depth was not a predictor of residual stenosis (OR: 1.19 [95% CI: 0.92-1.55]; P = 0.184), but more atrial implantation was protective against LVOT obstruction (0.7% vs 7.1%; P = 0.009; per 10% atrial, OR: 0.48 [95% CI: 0.24-0.98]; P = 0.044). Asymmetry was found to be an independent predictor of residual stenosis (per 10% increase, OR: 2.30 [95% CI: 1.10-4.82]; P = 0.027).
CONCLUSIONS: Valve stenosis is common after mitral ViV. Asymmetry was associated with residual stenosis. Depth of implantation on its own was not associated with residual stenosis but was associated with LVOT obstruction. Technical considerations to reduce postdeployment THV asymmetry should be considered.
Medical Subject Headings
Humans; Female; Middle Aged; Aged; Aged, 80 and over; Male; Mitral Valve; Heart Valve Prosthesis Implantation; Heart Valve Prosthesis; Constriction, Pathologic; Atrial Fibrillation; Treatment Outcome; Cardiac Catheterization; Hemodynamics; Registries; Prosthesis Design; Bioprosthesis
PubMed ID
37968032
Volume
16
Issue
21
First Page
2615
Last Page
2627
