Assessment of Bioprosthetic Valve Remodeling with Fracture procedure in Valve-in-Valve TAVR by Computed Tomography Angiography
Presenter
Go Hashimoto, Minneapolis Heart Institute® - Abbott Northwestern Hospital, Minneapolis, Minnesota
Go Hashimoto1, Joao L. Cavalcante, M.D.2, Hirotomo Sato, MD3, Bernardo BC. Lopes, MD4, Miho Fukuk, MD4, Mario Goessl, M.D., FSCAI5, Maurice Enriquez Sarano, MD3, Paul Sorajja, M.D., FSCAI5, John R. Lesser, M.D.5, Vinayak Bapat, M.D.5 and Santiago Garcia, M.D., FSCAI5, (1)Minneapolis Heart Institute® - Abbott Northwestern Hospital, Minneapolis, Minnesota, (2)Minneapolis Heart Institute® - Abbott Northwestern Hospital, Minneapolis, MN, (3)Minneapolios Heart Institute Foundation, Minneapolis, MN, (4)-, Minneapolis, MN, (5)Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, MN
Keywords: Heart Failure, Imaging & Physiology, Structural Heart Disease (SHD) and TAVI/TAVR/Aortic Valve
Background:
Bioprosthetic valve fracture (BVF) has been proposed as an adjunct to valve-in-valve (VIV) transcatheter aortic valve replacement (TAVR) procedures in small surgical valves.
The objectives of this investigation are 1) to quantify the remodeling effects of BVF on surgical valves using pre- and post-TAVR computed tomography (CTA) and 2) correlate changes in surgical inner valve area and implantation depth with residual gradients and effective orifice area index (EOAi).
Methods:
Using multimodality imaging and hemodynamics, we assessed the inner surgical valve area, implantation depth and periprocedural changes in invasive gradients, echo valve gradients, and echo effective orifice area index (EOAi).
Results:
A total of 11 patients underwent VIV TAVR with BFV and 41 patients VIV TAVR without BVF between July 2015 and November 2020. The mean age was 77±9 years. Patients undergoing VIV TAVR with BFV had larger gains (D) in surgical inner valve area (mm2) (+ 42 (25, 72) vs. +7 (0, 13), p<0.001) and larger reductions in peri-procedural invasive gradients (mmHg) (- 33[23, 48] vs. - 21[11, 32], p=0.042) despite smaller initial valve sizes (mm) (21 (21, 23) vs. 23 (23, 25), P=0.006) (Figure A). Among patients receiving VIV TAVR with BFV and self-expanding valves (N=9), implantation depth was inversely correlated to EOAi and directly correlated to mean gradient at 30-days (r= -0.728, p= 0.026, r= 0.775, p= 0.014, respectively) (Figure B).
Conclusions:
Addition of BVF to VIV TAVR produces significant remodeling of surgical valves, and when coupled with shallower implants, can result in significant gains in EOAi and reduction in residual gradients. 