Matched Comparison of Self-Expanding Transcatheter Heart Valves for the Treatment of Failed Aortic Surgical Bioprosthesis : Insights From the Valve-in-Valve International Data Registry (VIVID)

Alnasser, Sami;Cheema, Asim N.;Simonato, Matheus;Barbanti, Marco;Dvir, Danny;et.al.
(2017) Circulation. Cardiovascular Interventions — Vol. 10, n° 4, p. 1-8 (2017)

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Authors
  • Alnasser, Sami
    Author
  • Cheema, Asim N.
    Author
  • Simonato, Matheus
    Author
  • Barbanti, Marco
    Author
  • Kefer, JoëlleUCLouvain
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  • Dvir, Danny
    Author
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Abstract
Background— Transcatheter valve-in-valve implantation is an established therapy for high-risk patients with failed surgical aortic bioprosthesis. There are limited data comparing outcomes of valve-in-valve implantation using different transcatheter heart valves (THV). Methods and Results— Patients included in the Valve-in-Valve International Data registry (VIVID) and treated with self-expanding THV devices were analyzed using centralized core laboratory blinded to clinical events. St. Jude Medical Portico versus Medtronic CoreValve were compared in a 1:2 fashion after propensity score matching. A total of 162 patients, Portico- (n=54) and CoreValve- (n=108) based valve-in-valve procedures comprised the study population with no significant difference in baseline characteristics (age, 79±8.2 years; 60% women; mean STS [Society of Thoracic Surgery] score 8.1±5.5%). Postimplantation, CoreValve was associated with a larger effective orifice area (1.67 versus 1.31 cm2; P=0.001), lower mean gradient (14±7.5 versus 17±7.5 mm Hg; P=0.02), and lower core laboratory–adjudicated moderate-to-severe aortic insufficiency (4.2% versus 13.7%; P=0.04), compared with Portico. Procedural complications including THV malpositioning, second THV requirement, or coronary obstruction were not significantly different between the 2 groups. Survival and stroke rates at 30 days were similar, but overall mortality at 1 year was higher among patients treated with Portico compared with CoreValve (22.6% versus 9.1%; P=0.03). Conclusions— In this first matched comparison of THVs for valve-in-valve implantations, Portico and CoreValve demonstrated differences in postprocedural hemodynamics and long-term clinical outcomes. Although this could be related to THV design characteristics, the impact of other procedural factors cannot be excluded and require further evaluation.
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Alnasser, S., Cheema, A. N., Simonato, M., Barbanti, M., Edwards, J., Kornowski, R., Horlick, E., Wijeysundera, H. C., Testa, L., Bedogni, F., Amrane, H., Walther, T., Pelletier, M., Latib, A., Laborde, J.-C., Hildick-Smith, D., Kim, W.-K., Tchetche, D., Agrifoglio, M., et al. (2017). Matched Comparison of Self-Expanding Transcatheter Heart Valves for the Treatment of Failed Aortic Surgical Bioprosthesis : Insights From the Valve-in-Valve International Data Registry (VIVID). Circulation. Cardiovascular Interventions, 10(4), 1-8. https://doi.org/10.1161/circinterventions.116.004392 (Original work published 2017)