Hydrodynamic Assessment of Explanted Degenerated Transcatheter Aortic Valves: Novel Insights Into Noncalcific and Calcific Mechanisms.

Details

Serval ID
serval:BIB_8A2891E0F632
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Hydrodynamic Assessment of Explanted Degenerated Transcatheter Aortic Valves: Novel Insights Into Noncalcific and Calcific Mechanisms.
Journal
JACC. Cardiovascular interventions
Author(s)
Sathananthan J., Nigade A., Meier D., Navarro D., Spencer J., Lai A., Gill H., Pirelli L., Webb J.G., Wood D.A., Lutter G., Puehler T., Tang GHL, Fukuhara S., Sellers S.L.
ISSN
1876-7605 (Electronic)
ISSN-L
1936-8798
Publication state
Published
Issued date
10/06/2024
Peer-reviewed
Oui
Volume
17
Number
11
Pages
1340-1351
Language
english
Notes
Publication types: Journal Article ; Multicenter Study
Publication Status: ppublish
Abstract
The etiology of transcatheter aortic valve (TAV) degeneration is poorly understood, particularly noncalcific mechanisms.
The authors sought to investigate noncalcific and calcific mechanisms of TAV degeneration and evaluate their impact on leaflet function by bench testing, imaging, and histology.
TAV explants were obtained from the EXPLANT THV registry and clinical institutions. Hydrodynamic assessment was performed using a heart valve pulse duplicator system under physiological conditions. Micro-computed tomography, high-resolution photography, high speed video, and hematoxylin and eosin staining were used to evaluate the morphological appearance, leaflet kinematics, and calcium burden of TAVs.
A total of 14 explants were evaluated: 10 self-expanding CoreValve/Evolut TAVs (Medtronic), 3 balloon-expandable SAPIEN 3 TAVs (Edwards Lifesciences), and 1 mechanically expandable Lotus TAV (Boston Scientific). The median patient age at explantation was 73.0 years (Q1-Q3: 64.5-80.0 years), with a time to explantation of 4 years 1 month (1 year 5 months to 4 years 11 months). Six TAV explants were found to have leaflet calcification (162.4 mm <sup>3</sup> ; 58.8-603.0 mm <sup>3</sup> ), and 8 had no calcification detectable by micro-computed tomography and histology. All samples had impaired leaflet kinematics. There was no significant difference in the hydrodynamic mean gradient between calcified (47.2 mm Hg; 26.6-74.1 mm Hg) and noncalcified (27.6 mm Hg; 15.2-36.7 mm Hg; P = 0.28) TAVs. Leaflet calcification had a weak but nonsignificant association with the hydrodynamic mean gradient (r = 0.42; P = 0.14).
TAV function can be severely impacted by noncalcific and calcific mechanisms of tissue degeneration. Importantly, functional stenosis can occur in TAVs in the absence of obvious and significant calcification.
Keywords
Humans, Heart Valve Prosthesis, Aged, Aortic Valve/physiopathology, Aortic Valve/diagnostic imaging, Aortic Valve/surgery, Aortic Valve/pathology, Calcinosis/physiopathology, Calcinosis/diagnostic imaging, Calcinosis/pathology, Calcinosis/surgery, Female, Aged, 80 and over, Male, Hydrodynamics, X-Ray Microtomography, Prosthesis Design, Transcatheter Aortic Valve Replacement/instrumentation, Transcatheter Aortic Valve Replacement/adverse effects, Middle Aged, Prosthesis Failure, Registries, Time Factors, Device Removal, Aortic Valve Stenosis/physiopathology, Aortic Valve Stenosis/diagnostic imaging, Aortic Valve Stenosis/surgery, Hemodynamics, Biomechanical Phenomena, Materials Testing, Video Recording, TAVR explantation, calcification, degeneration and dysfunction, multimodality imaging, transcatheter aortic valve replacement
Pubmed
Open Access
Yes
Create date
14/06/2024 12:00
Last modification date
15/06/2024 7:03
Usage data