Incidence of Prosthesis-Patient Mismatch in Valve-in-Valve with a Supra-Annular Valve

Abstract

Background Transcatheter aortic valve replacement (TAVR) for a degenerated surgical bioprosthesis (valve-in-valve [ViV]) has become an established procedure. Elevated gradients and patient-prosthesis mismatch (PPM) have previously been reported in mixed TAVR cohorts. We analyzed our single-center experience using the third-generation self-expanding Medtronic Evolut R prosthesis, with an emphasis on the incidence and outcomes of PPM.

Methods This is a retrospective analysis of prospectively collected data from our TAVR database. Intraprocedural and intrahospital outcomes are reported.

Results Eighty-six patients underwent ViV-TAVR with the Evolut R prosthesis. Mean age was 75.5 ± 9.5 years, 64% were males. The mean log EuroScore was 21.6 ± 15.7%. The mean time between initial surgical valve implantation and ViV-TAVR was 8.8 ± 3.2 years. The mean true internal diameter of the implanted surgical valves was 20.9 ± 2.2 mm. Post-AVR, 60% had no PPM, 34% had moderate PPM, and 6% had severe PPM. After ViV-TAVR, 33% had no PPM, 29% had moderate, and 39% had severe PPM. After implantation, the mean transvalvular gradient was reduced significantly from 36.4 ± 15.2 to 15.5 ± 9.1 mm Hg (p < 0.001). No patient had more than mild aortic regurgitation after ViV-TAVR. No conversion to surgery was necessary. Estimated Kaplan–Meier survival at 1 year for all patients was 87.4%. One-year survival showed no significant difference according to post-ViV PPM groups (p = 0.356).

Conclusion ViV-TAVR using a supra-annular valve resulted in low procedural and in-hospital complication rates. However, moderate or severe PPM was common, with no influence on short-term survival. PPM may not be a suitable factor to predict survival after ViV-TAVR.

Keywords

heart valve - transapical - percutaneous - TAVI - aortic valve and root - reoperation

Abbreviations

TAVR: Transcatheter aortic valve replacement

ViV-TAVR: Valve-in-Valve transcatheter aortic valve replacement

PPM: patient-prosthesis mismatch

VARC-2 criteria: Valve Academic Research Consortium- 2 criteria

BMI: body mass index

BSA: body surface area

EOA: effective orifice area

AVR: aortic valve replacement

True ID: true internal diameter

VTC: virtual valve to coronary ostium distance

Publication History

Received: 18 April 2021

Accepted: 02 January 2022

Article published online:
07 March 2022

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