Impact of Commissural Misalignment on Hydrodynamic Function Following Valve-in-Valve Intervention With the ACURATE neo.

Details

Serval ID
serval:BIB_C6C20AD8842E
Type
Article: article from journal or magazin.
Collection
Publications
Title
Impact of Commissural Misalignment on Hydrodynamic Function Following Valve-in-Valve Intervention With the ACURATE neo.
Journal
JACC. Cardiovascular interventions
Author(s)
Meier D., Akodad M., Chatfield A.G., Lutter G., Puehler T., Søndergaard L., Wood D.A., Webb J.G., Sellers S.L., Sathananthan J.
ISSN
1876-7605 (Electronic)
ISSN-L
1936-8798
Publication state
Published
Issued date
08/08/2022
Peer-reviewed
Oui
Volume
15
Number
15
Pages
1532-1539
Language
english
Notes
Publication types: Journal Article ; Research Support, Non-U.S. Gov't
Publication Status: ppublish
Abstract
Limited evidence is available regarding valve-in-valve (VIV) intervention with the ACURATE neo transcatheter heart valve (THV). Low implantation has demonstrated leaflet interaction between the surgical bioprosthesis and the THV, leading to impaired hydrodynamic performance. It is unknown if commissural alignment (CA) can affect this phenomenon. Novel techniques have now been developed to achieve CA with the ACURATE neo THV.
The aim of this study was to assess the impact of commissural misalignment (CMA) on hydrodynamic function following VIV intervention with the ACURATE neo THV using a bench model.
VIV intervention was performed with the ACURATE neo (a self-expanding THV with supra-annular leaflet position) implanted deep in the surgical bioprosthetic aortic valve (Mitroflow). Hydrodynamic function at CA (0°) and 3 different degrees of CMA (30°, 60°, and 90°) was tested. As per the International Organization for Standardization, a regurgitant fraction <20% is considered optimal.
Following VIV, the central THV regurgitant fraction at 0°, 30°, 60°, and 90° of CMA was 8.6% ± 2.0%, 30.3% ± 12.0%, 42.6% ± 11.9%, and 66.7% ± 25.4% (P < 0.0001), respectively. On high-speed video there was no evidence of leaflet interaction at CA, whereas at 30°, 60°, and 90° of CMA there was clear evidence of THV leaflet interaction with those of the surgical valve, leading to impaired leaflet closure and to severe central THV regurgitation.
In VIV using the ACURATE neo THV at deep implantation, increasing degree of CMA was associated with THV leaflet interaction with those of the surgical valve and worsening regurgitant fraction. THV leaflet interaction was prevented when there was CA.
Keywords
Aortic Valve/diagnostic imaging, Aortic Valve/surgery, Aortic Valve Stenosis/diagnostic imaging, Aortic Valve Stenosis/surgery, Heart Valve Prosthesis, Humans, Hydrodynamics, Prosthesis Design, Transcatheter Aortic Valve Replacement/adverse effects, Treatment Outcome, ACURATE neo, commissural alignment, transcatheter heart valve, valve-in-valve
Pubmed
Web of science
Open Access
Yes
Create date
17/01/2025 5:53
Last modification date
24/02/2025 11:38
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