Timing of bioprosthetic valve fracture in transcatheter valve-in-valve intervention: impact on valve durability and leaflet integrity.
Details
Serval ID
serval:BIB_FFF1B292B90B
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Timing of bioprosthetic valve fracture in transcatheter valve-in-valve intervention: impact on valve durability and leaflet integrity.
Journal
EuroIntervention
ISSN
1969-6213 (Electronic)
ISSN-L
1774-024X
Publication state
Published
Issued date
20/02/2023
Peer-reviewed
Oui
Volume
18
Number
14
Pages
1165-1177
Language
english
Notes
Publication types: Journal Article
Publication Status: ppublish
Publication Status: ppublish
Abstract
Bioprosthetic valve fracture (BVF) can be used to improve transcatheter heart valve (THV) haemodynamics following a valve-in-valve (ViV) intervention. However, whether BVF should be performed before or after THV deployment and the implications on durability are unknown. Aims: We sought to assess the impact of BVF timing on long-term THV durability.
The impact of BVF timing was assessed using small ACURATE neo (ACn) or 23 mm SAPIEN 3 (S3) THV deployed in 21 mm Mitroflow valves compared to no-BVF controls. Valves underwent accelerated wear testing up to 200 million (M) cycles (equivalent to 5 years). At 200M cycles, THV were evaluated by hydrodynamic testing, second-harmonic generation (SHG) microscopy, scanning electron microscopy (SEM) and histology.
At 200M cycles, the regurgitant fraction (RF) and effective orifice area (EOA) for the ACn were 8.03±0.30%/1.74±0.01 cm <sup>2</sup> (no BVF), 12.48±0.70%/1.97±0.02 cm <sup>2</sup> (BVF before ViV) and 9.29±0.38%/2.21±0.0 cm <sup>2</sup> (BVF after ViV), respectively. For the S3 these values were 2.63±0.51%/1.26±0.01 cm <sup>2</sup> , 2.03±0.42%/1.65±0.01 cm <sup>2</sup> , and 1.62±0.38%/2.22±0.01 cm <sup>2</sup> , respectively. Further, SHG and SEM revealed a higher degree of superficial leaflet damage when BVF was performed after ViV for the ACn and S3. However, the histological analysis revealed significantly less damage, as determined by matrix density analysis, through the entire leaflet thickness when BVF was performed after ViV with the S3 and a similar but non-significant trend with the ACn. Conclusions: BVF performed after ViV appears to offer superior long-term EOA without increased RF. Ultrastructure leaflet analysis reveals that the timing of BVF can differentially impact leaflets, with more superficial damage but greater preservation of overall leaflet structure when BVF is performed after ViV.
The impact of BVF timing was assessed using small ACURATE neo (ACn) or 23 mm SAPIEN 3 (S3) THV deployed in 21 mm Mitroflow valves compared to no-BVF controls. Valves underwent accelerated wear testing up to 200 million (M) cycles (equivalent to 5 years). At 200M cycles, THV were evaluated by hydrodynamic testing, second-harmonic generation (SHG) microscopy, scanning electron microscopy (SEM) and histology.
At 200M cycles, the regurgitant fraction (RF) and effective orifice area (EOA) for the ACn were 8.03±0.30%/1.74±0.01 cm <sup>2</sup> (no BVF), 12.48±0.70%/1.97±0.02 cm <sup>2</sup> (BVF before ViV) and 9.29±0.38%/2.21±0.0 cm <sup>2</sup> (BVF after ViV), respectively. For the S3 these values were 2.63±0.51%/1.26±0.01 cm <sup>2</sup> , 2.03±0.42%/1.65±0.01 cm <sup>2</sup> , and 1.62±0.38%/2.22±0.01 cm <sup>2</sup> , respectively. Further, SHG and SEM revealed a higher degree of superficial leaflet damage when BVF was performed after ViV for the ACn and S3. However, the histological analysis revealed significantly less damage, as determined by matrix density analysis, through the entire leaflet thickness when BVF was performed after ViV with the S3 and a similar but non-significant trend with the ACn. Conclusions: BVF performed after ViV appears to offer superior long-term EOA without increased RF. Ultrastructure leaflet analysis reveals that the timing of BVF can differentially impact leaflets, with more superficial damage but greater preservation of overall leaflet structure when BVF is performed after ViV.
Keywords
Humans, Transcatheter Aortic Valve Replacement, Heart Valve Prosthesis, Bioprosthesis, Prosthesis Design, Aortic Valve/surgery, Aortic Valve Stenosis/surgery, Treatment Outcome
Pubmed
Web of science
Create date
17/01/2025 5:48
Last modification date
24/02/2025 11:48