Valve-in-Valve Implantation Using the ACURATE Neo in Degenerated Aortic Bioprostheses: An International Multicenter Analysis

Andreas Holzamer; Won-Keun Kim; Andreas Rück; Janarthanan Sathananthan; Lukas Keller; Joseph Cosma; Timm Bauer; Holger Nef; Ignacio J Amat-Santos; Miriam Brinkert; Oliver Husser; Costanza Pellegrini; Joachim Schofer; Roberto Nerla; Matteo Montorfano; Francesco Giannini; Pieter Stella; Shingo Kuwata; Michael Hilker; Fausto Castriota; Gian Paolo Ussia; John G Webb; Fabian Nietlispach; Stefan Toggweiler

doi:10.1016/j.jcin.2019.07.042

Valve-in-Valve Implantation Using the ACURATE Neo in Degenerated Aortic Bioprostheses: An International Multicenter Analysis

Andreas Holzamer, Won-Keun Kim, Andreas Rück, Janarthanan Sathananthan, Lukas Keller, Joseph Cosma, Timm Bauer, Holger Nef, Ignacio J Amat-Santos, Miriam Brinkert, Oliver Husser, Costanza Pellegrini, Joachim Schofer, Roberto Nerla, Matteo Montorfano, Francesco Giannini, Pieter Stella, Shingo Kuwata, Michael Hilker, Fausto CastriotaGian Paolo Ussia, John G Webb, Fabian Nietlispach, Stefan Toggweiler

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

OBJECTIVES: This study reports an international experience using the transfemoral ACURATE neo transcatheter heart valve (Boston Scientific, Marlborough, Massachusetts) for the treatment of degenerated surgical aortic bioprostheses.

BACKGROUND: Transcatheter valve-in-valve procedures have emerged as an alternative to redo surgery. Supra-annular prostheses might be particularly useful in this indication.

METHODS: This is an international multicenter analysis including 85 patients from 14 centers in Europe and Canada undergoing an ACURATE neo valve-in-valve procedure from March 2015 to February 2019.

RESULTS: Internal diameter of the degenerated bioprosthesis was 20.3 ± 2.1 mm. Prosthesis size S was used in 70 (82%) procedures. The median depth of implantation was 3 mm and the upper crown of the ACURATE neo was positioned above the stent posts of the degenerated bioprosthesis in 54 (64%) and inside in 31 (36%). Mean transvalvular gradient before discharge was significantly lower if the upper crown was above the degenerated bioprosthesis (13.7 ± 5.9 mm Hg vs. 19.5 ± 10.0 mm Hg; p = 0.001). However, a high position of the ACURATE neo resulted in embolization in 1 patient, conversion to open-heart surgery in 1, and need for reintervention due to transcatheter heart valve failure within the first 18 months of follow-up in 4.

CONCLUSIONS: This early experience shows that a high implantation of the ACURATE neo with the upper crown above the stent posts of the degenerated bioprosthesis resulted in lower mean transvalvular gradients but a higher rate of malpositioning and early valve degeneration.

Original language	English
Pages (from-to)	2309-2316
Number of pages	8
Journal	JACC. Cardiovascular Interventions
Volume	12
Issue number	22
DOIs	https://doi.org/10.1016/j.jcin.2019.07.042
Publication status	Published - 25 Nov 2019

Keywords

AVA, aortic valve area
ID, inner diameter
PPM, prosthesis-patient mismatch
THV, transcatheter heart valve
ViV, valve-in-valve
transcatheter aortic valve implantation
transfemoral
transcatheter aortic valve replacement
valve-in-valve
degenerated bioprosthesis

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10.1016/j.jcin.2019.07.042

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Holzamer, A., Kim, W.-K., Rück, A., Sathananthan, J., Keller, L., Cosma, J., Bauer, T., Nef, H., Amat-Santos, I. J., Brinkert, M., Husser, O., Pellegrini, C., Schofer, J., Nerla, R., Montorfano, M., Giannini, F., Stella, P., Kuwata, S., Hilker, M., ... Toggweiler, S. (2019). Valve-in-Valve Implantation Using the ACURATE Neo in Degenerated Aortic Bioprostheses: An International Multicenter Analysis. JACC. Cardiovascular Interventions, 12(22), 2309-2316. https://doi.org/10.1016/j.jcin.2019.07.042

@article{8a183198d1334c44a24521461eb5f059,

title = "Valve-in-Valve Implantation Using the ACURATE Neo in Degenerated Aortic Bioprostheses: An International Multicenter Analysis",

abstract = "OBJECTIVES: This study reports an international experience using the transfemoral ACURATE neo transcatheter heart valve (Boston Scientific, Marlborough, Massachusetts) for the treatment of degenerated surgical aortic bioprostheses.BACKGROUND: Transcatheter valve-in-valve procedures have emerged as an alternative to redo surgery. Supra-annular prostheses might be particularly useful in this indication.METHODS: This is an international multicenter analysis including 85 patients from 14 centers in Europe and Canada undergoing an ACURATE neo valve-in-valve procedure from March 2015 to February 2019.RESULTS: Internal diameter of the degenerated bioprosthesis was 20.3 ± 2.1 mm. Prosthesis size S was used in 70 (82%) procedures. The median depth of implantation was 3 mm and the upper crown of the ACURATE neo was positioned above the stent posts of the degenerated bioprosthesis in 54 (64%) and inside in 31 (36%). Mean transvalvular gradient before discharge was significantly lower if the upper crown was above the degenerated bioprosthesis (13.7 ± 5.9 mm Hg vs. 19.5 ± 10.0 mm Hg; p = 0.001). However, a high position of the ACURATE neo resulted in embolization in 1 patient, conversion to open-heart surgery in 1, and need for reintervention due to transcatheter heart valve failure within the first 18 months of follow-up in 4.CONCLUSIONS: This early experience shows that a high implantation of the ACURATE neo with the upper crown above the stent posts of the degenerated bioprosthesis resulted in lower mean transvalvular gradients but a higher rate of malpositioning and early valve degeneration.",

keywords = "AVA, aortic valve area, ID, inner diameter, PPM, prosthesis-patient mismatch, THV, transcatheter heart valve, ViV, valve-in-valve, transcatheter aortic valve implantation, transfemoral, transcatheter aortic valve replacement, valve-in-valve, degenerated bioprosthesis",

author = "Andreas Holzamer and Won-Keun Kim and Andreas R{\"u}ck and Janarthanan Sathananthan and Lukas Keller and Joseph Cosma and Timm Bauer and Holger Nef and Amat-Santos, {Ignacio J} and Miriam Brinkert and Oliver Husser and Costanza Pellegrini and Joachim Schofer and Roberto Nerla and Matteo Montorfano and Francesco Giannini and Pieter Stella and Shingo Kuwata and Michael Hilker and Fausto Castriota and Ussia, {Gian Paolo} and Webb, {John G} and Fabian Nietlispach and Stefan Toggweiler",

year = "2019",

month = nov,

day = "25",

doi = "10.1016/j.jcin.2019.07.042",

language = "English",

volume = "12",

pages = "2309--2316",

journal = "JACC. Cardiovascular Interventions",

issn = "1936-8798",

publisher = "Elsevier",

number = "22",

}

Holzamer, A, Kim, W-K, Rück, A, Sathananthan, J, Keller, L, Cosma, J, Bauer, T, Nef, H, Amat-Santos, IJ, Brinkert, M, Husser, O, Pellegrini, C, Schofer, J, Nerla, R, Montorfano, M, Giannini, F, Stella, P, Kuwata, S, Hilker, M, Castriota, F, Ussia, GP, Webb, JG, Nietlispach, F & Toggweiler, S 2019, 'Valve-in-Valve Implantation Using the ACURATE Neo in Degenerated Aortic Bioprostheses: An International Multicenter Analysis', JACC. Cardiovascular Interventions, vol. 12, no. 22, pp. 2309-2316. https://doi.org/10.1016/j.jcin.2019.07.042

TY - JOUR

T1 - Valve-in-Valve Implantation Using the ACURATE Neo in Degenerated Aortic Bioprostheses

T2 - An International Multicenter Analysis

AU - Holzamer, Andreas

AU - Kim, Won-Keun

AU - Rück, Andreas

AU - Sathananthan, Janarthanan

AU - Keller, Lukas

AU - Cosma, Joseph

AU - Bauer, Timm

AU - Nef, Holger

AU - Amat-Santos, Ignacio J

AU - Brinkert, Miriam

AU - Husser, Oliver

AU - Pellegrini, Costanza

AU - Schofer, Joachim

AU - Nerla, Roberto

AU - Montorfano, Matteo

AU - Giannini, Francesco

AU - Stella, Pieter

AU - Kuwata, Shingo

AU - Hilker, Michael

AU - Castriota, Fausto

AU - Ussia, Gian Paolo

AU - Webb, John G

AU - Nietlispach, Fabian

AU - Toggweiler, Stefan

PY - 2019/11/25

Y1 - 2019/11/25

N2 - OBJECTIVES: This study reports an international experience using the transfemoral ACURATE neo transcatheter heart valve (Boston Scientific, Marlborough, Massachusetts) for the treatment of degenerated surgical aortic bioprostheses.BACKGROUND: Transcatheter valve-in-valve procedures have emerged as an alternative to redo surgery. Supra-annular prostheses might be particularly useful in this indication.METHODS: This is an international multicenter analysis including 85 patients from 14 centers in Europe and Canada undergoing an ACURATE neo valve-in-valve procedure from March 2015 to February 2019.RESULTS: Internal diameter of the degenerated bioprosthesis was 20.3 ± 2.1 mm. Prosthesis size S was used in 70 (82%) procedures. The median depth of implantation was 3 mm and the upper crown of the ACURATE neo was positioned above the stent posts of the degenerated bioprosthesis in 54 (64%) and inside in 31 (36%). Mean transvalvular gradient before discharge was significantly lower if the upper crown was above the degenerated bioprosthesis (13.7 ± 5.9 mm Hg vs. 19.5 ± 10.0 mm Hg; p = 0.001). However, a high position of the ACURATE neo resulted in embolization in 1 patient, conversion to open-heart surgery in 1, and need for reintervention due to transcatheter heart valve failure within the first 18 months of follow-up in 4.CONCLUSIONS: This early experience shows that a high implantation of the ACURATE neo with the upper crown above the stent posts of the degenerated bioprosthesis resulted in lower mean transvalvular gradients but a higher rate of malpositioning and early valve degeneration.

AB - OBJECTIVES: This study reports an international experience using the transfemoral ACURATE neo transcatheter heart valve (Boston Scientific, Marlborough, Massachusetts) for the treatment of degenerated surgical aortic bioprostheses.BACKGROUND: Transcatheter valve-in-valve procedures have emerged as an alternative to redo surgery. Supra-annular prostheses might be particularly useful in this indication.METHODS: This is an international multicenter analysis including 85 patients from 14 centers in Europe and Canada undergoing an ACURATE neo valve-in-valve procedure from March 2015 to February 2019.RESULTS: Internal diameter of the degenerated bioprosthesis was 20.3 ± 2.1 mm. Prosthesis size S was used in 70 (82%) procedures. The median depth of implantation was 3 mm and the upper crown of the ACURATE neo was positioned above the stent posts of the degenerated bioprosthesis in 54 (64%) and inside in 31 (36%). Mean transvalvular gradient before discharge was significantly lower if the upper crown was above the degenerated bioprosthesis (13.7 ± 5.9 mm Hg vs. 19.5 ± 10.0 mm Hg; p = 0.001). However, a high position of the ACURATE neo resulted in embolization in 1 patient, conversion to open-heart surgery in 1, and need for reintervention due to transcatheter heart valve failure within the first 18 months of follow-up in 4.CONCLUSIONS: This early experience shows that a high implantation of the ACURATE neo with the upper crown above the stent posts of the degenerated bioprosthesis resulted in lower mean transvalvular gradients but a higher rate of malpositioning and early valve degeneration.

KW - AVA, aortic valve area

KW - ID, inner diameter

KW - PPM, prosthesis-patient mismatch

KW - THV, transcatheter heart valve

KW - ViV, valve-in-valve

KW - transcatheter aortic valve implantation

KW - transfemoral

KW - transcatheter aortic valve replacement

KW - valve-in-valve

KW - degenerated bioprosthesis

UR - http://www.scopus.com/inward/record.url?scp=85074644199&partnerID=8YFLogxK

U2 - 10.1016/j.jcin.2019.07.042

DO - 10.1016/j.jcin.2019.07.042

M3 - Article

C2 - 31753302

SN - 1936-8798

VL - 12

SP - 2309

EP - 2316

JO - JACC. Cardiovascular Interventions

JF - JACC. Cardiovascular Interventions

IS - 22

ER -

Valve-in-Valve Implantation Using the ACURATE Neo in Degenerated Aortic Bioprostheses: An International Multicenter Analysis

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Keywords

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