Redo-TAVI with SAPIEN 3 in SAPIEN XT or SAPIEN 3 - impact of pre- and post-dilatation on final THV expansion.

Details

Serval ID
serval:BIB_17D029201104
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Redo-TAVI with SAPIEN 3 in SAPIEN XT or SAPIEN 3 - impact of pre- and post-dilatation on final THV expansion.
Journal
EuroIntervention
Author(s)
Meier D., Landes U., Sondergaard L., De Backer O., Lutter G., Puehler T., Akodad M., Tzimas G., Blanke P., Payne G.W., Lai A., Gill H., Wood D.A., Webb J.G., Sellers S.L., Sathananthan J.
ISSN
1969-6213 (Electronic)
ISSN-L
1774-024X
Publication state
Published
Issued date
17/11/2023
Peer-reviewed
Oui
Volume
19
Number
9
Pages
757-765
Language
english
Notes
Publication types: Journal Article
Publication Status: ppublish
Abstract
When a balloon-expandable transcatheter heart valve (THV) is chosen to treat a failed balloon-expandable THV, there is a risk of underexpansion with a potential impact on performance.
We aimed to assess the impact of pre- and post-dilatation on the expansion of balloon-expandable THVs after redo-transcatheter aortic valve implantation (TAVI).
Redo-TAVI was performed on the bench with a 23 mm SAPIEN 3 (S3) implanted within a 23 mm SAPIEN XT (SXT) or a 23 mm S3, both of which served as the "failed" THVs. Pre- and/or post-dilatation was performed using a 23 mm non-compliant TRUE balloon. Expansion of the index and redo-THVs were assessed before and after pre-/post-dilatation using microcomputed tomography (micro-CT), and THV hydrodynamic testing was conducted.
Without pre- or post-dilatation, the S3 was underexpanded, for all combinations, particularly in the mid-portion of the THV (18.6 mm and 19.7 mm representing 81% and 86% of the nominal diameter inside the SXT and S3, respectively). Pre- and post-dilatation had an additive effect on diameter expansion of the redo-THV, which remained constrained in most combinations. The only combination to achieve nominal expansion was the S3 in S3 when both pre- and post-dilatation were performed. The S3 remained underexpanded inside the SXT despite pre- and post-dilatation (93% in the mid-portion). Improved redo-THV expansion was accompanied by 2.7 mm (12%) overexpansion of the index THV. While all samples had acceptable hydrodynamic performance, the underexpanded samples had worse leaflet pinwheeling.
When performing redo-TAVI with a 23 mm S3 inside a 23 mm SXT or S3, only the S3 in S3 with the use of pre- and post-dilatation reached full expansion. This underlines the importance of CT assessment of THV expansion and the role of pre-/post-dilatation.
Keywords
Humans, Transcatheter Aortic Valve Replacement/methods, Aortic Valve Insufficiency/surgery, Aortic Valve Stenosis/diagnostic imaging, Aortic Valve Stenosis/surgery, X-Ray Microtomography, Dilatation, Heart Valve Prosthesis, Treatment Outcome, Aortic Valve/diagnostic imaging, Aortic Valve/surgery, Prosthesis Design
Pubmed
Web of science
Create date
17/01/2025 5:36
Last modification date
17/01/2025 7:04
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