Author + information
- Received February 8, 2019
- Revision received May 15, 2019
- Accepted May 17, 2019
- Published online July 1, 2019.
- Matthew Miller, BSa,b,
- Mandy Snyder, APRNc,d,
- Benjamin D. Horne, PhD, MStat, MPHa,e,
- James R. Harkness, MDa,
- John R. Doty, MDa,
- Edward C. Miner, MDa,
- Kent W. Jones, MDa,
- Kelly R. O’Neal, MDa,
- Bruce B. Reid, MDa,
- William T. Caine, MDa,
- Stephen E. Clayson, MDa,
- Eric Lindley, MDf,
- Blake Gardner, MDg,
- Rafe C. Connors, MDf,
- B. Jason Bowles, MDg and
- Brian K. Whisenant, MDa,∗ (, )@whisenant_brian
- aIntermountain Heart Institute, Salt Lake City, UtahIntermountain Heart Institute, Salt Lake City, Utah
- bUniversity of Utah, Division of Cardiology, Salt Lake City, UtahUniversity of Utah, Division of Cardiology, Salt Lake City, Utah
- cEdwards Lifesciences, Irvine, CaliforniaEdwards Lifesciences, Irvine, California
- dDepartment of Nursing, University of Utah, Salt Lake City, UtahDepartment of Nursing, University of Utah, Salt Lake City, Utah
- eDepartment of Biomedical Informatics, University of Utah, Salt Lake City, UtahDepartment of Biomedical Informatics, University of Utah, Salt Lake City, Utah
- fMcKay Dee Hospital, Ogden, UtahMcKay Dee Hospital, Ogden, Utah
- gDixie Regional Medical Center, St. George, UtahDixie Regional Medical Center, St. George, Utah
- ↵∗Address for correspondence:
Dr. Brian Whisenant, Intermountain Medical Center, Building 4, L6, 5121 Cottonwood Street, Salt Lake City, Utah 84107.
Objectives The purpose of this study was to evaluate the safety and efficacy of valve-in-valve (ViV) transcatheter aortic valve replacement (TAVR) for stentless bioprosthetic aortic valves (SBAVs) and to identify predictors of adverse events.
Background ViV TAVR in SBAVs is associated with unique technical challenges and risks.
Methods Clinical records and computer tomographic scans were retrospectively reviewed for procedural complications, predictors of coronary obstruction, mortality, and echocardiographic results.
Results Among 66 SBAV patients undergoing ViV TAVR, mortality was 2 of 66 patients (3.0%) at 30 days and 5 of 52 patients (9.6%) at 1 year. At 1 year, left ventricular end-systolic dimension was decreased versus baseline (median [interquartile range (IQR)]: 3.0 [2.6 to 3.6] cm vs. 3.7 [3.2 to 4.4] cm; p < 0.001). Coronary occlusion in 6 of 66 procedures (9.1%) resulted in myocardial infarction in 2 of 66 procedures (3.0%). Predictors of coronary occlusion included subcoronary implant technique compared with full root replacement (6 of 31, 19.4% vs. 0 of 28, 0%; p = 0.01), short simulated radial valve-to-coronary distance (median [IQR]: 3.4 [0.0 to 4.6] mm vs. 4.6 [3.2 to 6.2] mm; p = 0.016), and low coronary height (7.8 [5.8 to 10.0] mm vs. 11.6 [8.7 to 13.9] mm; p = 0.003). Coronary arteries originated <10 mm above the valve leaflets in 34 of 97 unobstructed coronary arteries (35.1%).
Conclusions TAVR in SBAVs is frequently associated with high-risk coronary anatomy but can be performed with a low risk of death and myocardial infarction, resulting in favorable ventricular remodeling. A subcoronary surgical approach is associated with an increased risk of coronary obstruction.
This project was supported by a grant from the Intermountain Research and Medical Foundation. Dr. Snyder is an employee of and holds stock in Edwards Lifesciences. Dr. Miner is a consultant for Edwards Lifesciences. Dr. Lindley is a consultant for Abbott Vascular. Dr. Bowles is a consultant for Medtronic. Dr. Whisenant is a consultant for Abbott Vascular, Edwards Lifesciences, and Boston Scientific. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received February 8, 2019.
- Revision received May 15, 2019.
- Accepted May 17, 2019.
- 2019 American College of Cardiology Foundation
This article requires a subscription or purchase to view the full text. If you are a subscriber or member, click Login or the Subscribe link (top menu above) to access this article.