Author + information
- Received April 22, 2019
- Revision received June 26, 2019
- Accepted July 23, 2019
- Published online November 18, 2019.
- Andreas Holzamer, MDa,
- Won-Keun Kim, MDb,
- Andreas Rück, MDc,
- Janarthanan Sathananthan, MBChB, MPHd,
- Lukas Keller, MDe,
- Joseph Cosma, MDf,
- Timm Bauer, MDg,
- Holger Nef, MDg,
- Ignacio J. Amat-Santos, MDh,
- Miriam Brinkert, MDi,
- Oliver Husser, MDj,
- Costanza Pellegrini, MDj,
- Joachim Schofer, MDk,
- Roberto Nerla, MDl,
- Matteo Montorfano, MDm,
- Francesco Giannini, MDm,
- Pieter Stella, MD, PhDn,
- Shingo Kuwata, MDe,
- Michael Hilker, MDa,
- Fausto Castriota, MDl,
- Gian Paolo Ussia, MDf,
- John G. Webb, MDd,
- Fabian Nietlispach, MD, PhDe and
- Stefan Toggweiler, MDi,∗ ()
- aDepartment of Cardiothoracic Surgery, University of Regensburg Medical Center, Regensburg, Germany
- bDepartment of Cardiology and Cardiac Surgery, Kerckhoff Heart and Lung Center, Bad Nauheim, Germany
- cDepartment of Medicine, Unit of Cardiology, Karolinska University Hospital, Stockholm, Sweden
- dCentre for Heart Valve Innovation, St. Paul’s and Vancouver General Hospitals, University of British Columbia, Vancouver, Canada
- eDepartment of Cardiology, University Hospital Zürich, Zurich, Switzerland
- fDepartment of Cardiology, University Campus Bio/Medico, University of Rome Tor Vergata, Rome, Italy
- gDepartment of Cardiology, University Hospital Giessen, Giessen, Germany
- hCentro de Investigación Biomédica en Red Enfermedades Cardiovasculares, Department of Cardiology, Hospital Universitario de Valladolid, Valladolid, Spain
- iDivision of Cardiology, Heart Center Lucerne, Luzerner Kantonsspital, Lucerne, Switzerland
- jKlinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Munich, Germany
- kAlbertinen Herzzentrum und Medizinisches Versorgungszentrum Prof. Dr. Mathey, Hamburg, Germany
- lCardiovascular Department, Humanitas Gavazzeni, Bergmo, Italy
- mInterventional Cardiology Unit, San Raffaele Institute, Milan, Italy
- nDepartment of Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands
- ↵∗Address for correspondence:
Dr. Stefan Toggweiler, Division of Cardiology, Heart Center Lucerne, Luzerner Kantonsspital, Spitalstrasse, 6000 Lucerne, Switzerland.
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.
- degenerated bioprosthesis
- transcatheter aortic valve implantation
- transcatheter aortic valve replacement
Drs. Holzamer and Hilker have served as proctors for and received research grant support from Boston Scientific. Dr. Kim has served as a proctor for Boston Scientific, Abbott, and Edwards Lifesciences; and has received speaker fees from Edwards Lifesciences, Abbott, Medtronic, and Symetis/Boston Scientific. Dr. Rück has received lecture fees from Boston Scientific and Edwards Lifesciences; and has received research grant support from Boston Scientific. Dr. Sathananthan has served as a consultant for Edwards Lifesciences. Drs. Amat-Santos, Husser, and Stella have served as a proctor for Boston Scientific. Dr. Pellegrini has received minor travel grants from Boston Scientific and Edwards Lifesciences. Dr. Castriota has served as a proctor and consultant for Boston Scientific; and has served as a consultant for Medtronic, Abbott, and Terumo. Dr. Webb is a consultant to, and has received research funding from, Edwards Lifesciences, Abbott, and ViVitro Labs; and is a proctor for Boston Scientific. Dr. Nietlispach has served as a consultant for Edwards Lifesciences, Abbott Vascular, and Medtronic. Dr. Toggweiler has served as a proctor and consultant for Boston Scientific and New Valve Technology; and has received an institutional research grant from Boston Scientific. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received April 22, 2019.
- Revision received June 26, 2019.
- Accepted July 23, 2019.
- 2019 American College of Cardiology Foundation
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