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Matched Comparison of Self-Expanding Transcatheter Heart Valves for the Treatment of Failed Aortic Surgical Bioprosthesis : Insights From the Valve-in-Valve International Data Registry (VIVID)

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Alnasser, Sami Cheema, Asim N. Simonato, Matheus Barbanti, Marco Edwards, Jeremy Kefer, Joëlle [UCL] Dvir, Danny

Background— Transcatheter valve-in-valve implantation is an established therapy for high-risk patients with failed surgical aortic bioprosthesis. There are limited data comparing outcomes of valve-in-valve implantation using different transcatheter heart valves (THV). Methods and Results— Patients included in the Valve-in-Valve International Data registry (VIVID) and treated with self-expanding THV devices were analyzed using centralized core laboratory blinded to clinical events. St. Jude Medical Portico versus Medtronic CoreValve were compared in a 1:2 fashion after propensity score matching. A total of 162 patients, Portico- (n=54) and CoreValve- (n=108) based valve-in-valve procedures comprised the study population with no significant difference in baseline characteristics (age, 79±8.2 years; 60% women; mean STS [Society of Thoracic Surgery] score 8.1±5.5%). Postimplantation, CoreValve was associated with a larger effective orifice area (1.67 versus 1.31 cm2; P=0.001), lower mean gradient (14±7.5 versus 17±7.5 mm Hg; P=0.02), and lower core laboratory–adjudicated moderate-to-severe aortic insufficiency (4.2% versus 13.7%; P=0.04), compared with Portico. Procedural complications including THV malpositioning, second THV requirement, or coronary obstruction were not significantly different between the 2 groups. Survival and stroke rates at 30 days were similar, but overall mortality at 1 year was higher among patients treated with Portico compared with CoreValve (22.6% versus 9.1%; P=0.03). Conclusions— In this first matched comparison of THVs for valve-in-valve implantations, Portico and CoreValve demonstrated differences in postprocedural hemodynamics and long-term clinical outcomes. Although this could be related to THV design characteristics, the impact of other procedural factors cannot be excluded and require further evaluation.

Document type Article de périodique (Journal article)
Access type Accès libre
Publication date 2017
Language Anglais
Journal information "Circulation: Cardiovascular Interventions" - Vol. 10, no.4, p. 1-8 (2017)
Peer reviewed yes
Publisher Ovid Technologies (Wolters Kluwer Health)
issn 1941-7640
e-issn 1941-7632
Publication status Publié
Affiliations UCL - (SLuc) Département cardiovasculaire
UCL - SSS/IREC/CARD - Pôle de recherche cardiovasculaire
Links
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Bibliographic reference Alnasser, Sami ; Cheema, Asim N. ; Simonato, Matheus ; Barbanti, Marco ; Edwards, Jeremy ; et. al. Matched Comparison of Self-Expanding Transcatheter Heart Valves for the Treatment of Failed Aortic Surgical Bioprosthesis : Insights From the Valve-in-Valve International Data Registry (VIVID). In: Circulation: Cardiovascular Interventions, Vol. 10, no.4, p. 1-8 (2017)
Permanent URL http://hdl.handle.net/2078.1/220259