Author + information
- Received June 19, 2017
- Revision received August 14, 2017
- Accepted August 29, 2017
- Published online January 15, 2018.
- Philippe Pibarot, DVM, PhDa,∗ (, )
- Matheus Simonatob,
- Marco Barbanti, MDc,
- Axel Linke, MDd,
- Ran Kornowski, MDe,
- Tanja Rudolph, MDf,
- Mark Spence, MB, BChg,
- Neil Moat, MBBS, MSh,
- Gabriel Aldea, MDi,
- Marco Mennuni, MDj,
- Alessandro Iadanza, MDk,
- Hafid Amrane, MDl,
- Diego Gaia, MD, PhDb,
- Won-Keun Kim, MDm,
- Massimo Napodano, MDn,
- Hardy Baumbach, MDo,
- Ariel Finkelstein, MDp,
- Junjiro Kobayashi, MD, PhDq,
- Stephen Brecker, MDr,
- Creighton Don, MD, PhDi,
- Alfredo Cerillo, MDs,
- Axel Unbehaun, MDt,
- David Attias, MDu,
- Mohammed Nejjari, MDu,
- Noah Jones, MDv,
- Claudia Fiorina, MDw,
- Didier Tchetche, MDx,
- Raphael Philippart, MDx,
- Konstantinos Spargias, MDy,
- Jose-Maria Hernandez, MD, PhDz,
- Azeem Latib, MDaa and
- Danny Dvir, MDi
- aInstitut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec City, Quebec, Canada
- bEscola Paulista de Medicina – UNIFESP, São Paulo, Brazil
- cFerraroto Hospital, Catania, Italy
- dUniversität Leipzig, Leipzig, Germany
- eRabin Medical Center, Petah Tikva, Israel
- fUniklinik Köln Herzzentrum, Cologne, Germany
- gBelfast Health and Social Care Trust, Belfast, United Kingdom
- hRoyal Brompton & Harefield NHS Foundation Trust, London, United Kingdom
- iUniversity of Washington, Seattle, Washington
- jHumanitas Hospital, Milan, Italy
- kAzienda Ospedaliera Universitaria Senese, Siena, Italy
- lMedisch Centrum Leeuwarden, Leeuwarden, the Netherlands
- mKerckhoff Klinik, Bad Nauheim, Germany
- nUniversity of Padova, Padova, Italy
- oRobert-Bosch-Krankenhaus, Stuttgart, Germany
- pTel Aviv Sourasky Medical Center, Tel Aviv, Israel
- qNational Cerebral and Cardiovascular Center, Osaka, Japan
- rSt. George’s, University of London, London, United Kingdom
- sFondazione Toscana Gabriele Monasterio, Pisa, Italy
- tDeutsches Herzzentrum Berlin, Berlin, Germany
- uCentre Cardiologique du Nord, Saint Denis, France
- vMount Carmel Columbus, Columbus, Ohio
- wSpedali Civili di Brescia, Brescia, Italy
- xClinique Pasteur, Toulouse, France
- yHygeia Hospital, Athens, Greece
- zHospital Universitario Virgen de la Victoria, Malaga, Spain
- aaOspedale di San Raffaele, Milan, Italy
- ↵∗Address for correspondence:
Dr. Philippe Pibarot, Institut Universitaire de Cardiologie et de Pneumologie de Québec, 2725 Chemin Sainte-Foy, Québec QC G1V 4G5, Canada.
Objectives The aim of this study was to determine whether the association of small label size of the surgical valve with increased mortality after transcatheter valve-in-valve (ViV) implantation is, at least in part, related to pre-existing prosthesis-patient mismatch (PPM) (i.e., a bioprosthesis that is too small in relation to body size).
Background Transcatheter ViV implantation is an alternative for the treatment of patients with degenerated bioprostheses. Small label size of the surgical valve has been associated with increased mortality after ViV implantation.
Methods Data from 1,168 patients included in the VIVID (Valve-in-Valve International Data) registry were analyzed. Pre-existing PPM of the surgical valve was determined using a reference value of effective orifice area for each given model and size of implanted prosthetic valve indexed for body surface area. Severe PPM was defined according to the criteria proposed by the Valve Academic Research Consortium 2: indexed effective orifice area <0.65 cm2/m2 if body mass index is <30 kg/m2 and <0.6 cm2/m2 if BMI is ≥30 kg/m2. The primary study endpoint was 1-year mortality.
Results Among the 1,168 patients included in the registry, 89 (7.6%) had pre-existing severe PPM. Patients with severe PPM had higher 30-day (10.3%, p = 0.01) and 1-year (unadjusted: 28.6%, p < 0.001; adjusted: 19.3%, p = 0.03) mortality rates compared with patients with no severe PPM (4.3%, 11.9%, and 10.9%, respectively). After adjusting for surgical valve label size, Society of Thoracic Surgeons score, renal failure, diabetes, and stentless surgical valves, presence of pre-existing severe PPM was associated with increased risk for 1-year mortality (odds ratio: 1.88; 95% confidence interval: 1.07 to 3.28; p = 0.03). Patients with severe PPM also more frequently harbored high post-procedural gradients (mean gradient ≥20 mm Hg).
Conclusions Pre-existing PPM of the failed surgical valve is strongly and independently associated with increased risk for mortality following ViV implantation.
Dr. Pibarot is the Canada Research Chair in Valvular Heart Disease; his research program is funded by the Canadian Institutes of Health Research (grant FDN-143225); and has received research grants from Edwards Lifesciences and Medtronic for echocardiography core laboratory analyses in transcatheter heart valves. Dr. Dvir is a consultant for Edwards Lifesciences, Medtronic, and St. Jude Medical. Dr. Moat has received consulting and speaking fees from Abbott, Edwards Lifesciences, and Medtronic. Dr. Latib is a consultant for Medtronic; has received speaking honoraria from Abbott Vascular; and research grants from Medtronic and Edwards Lifesciences. Dr. Kim is a proctor for Symetis and St. Jude Medical. Dr. Linke is a consultant for Medtronic, St. Jude Medical, Claret Medical, Boston Scientific, Edwards Lifesciences, Symetis, and Bard; and owns stock options in Claret Medical. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received June 19, 2017.
- Revision received August 14, 2017.
- Accepted August 29, 2017.
- 2018 American College of Cardiology Foundation