Author + information
- Received August 1, 2019
- Revision received October 4, 2019
- Accepted October 8, 2019
- Published online March 16, 2020.
- Mark Hensey, MB BCh, BAO,
- Stephanie Sellers, PhD,
- Janarthanan Sathananthan, MBChB, MPH,
- Althea Lai,
- Uri Landes, MD,
- Abdullah Alkhodair, MD,
- Bruce McManus, PhD,
- Anson Cheung, MD,
- David Wood, MD,
- Philipp Blanke, MD,
- Jonathon Leipsic, MD,
- Jian Ye, MD and
- John Webb, MD∗ ()
- Centre for Heart Valve Innovation, St. Paul’s Hospital, University of British Columbia, Vancouver, British Columbia, Canada
- ↵∗Address for correspondence:
Dr. John Webb, St. Paul’s Hospital, 1081 Burrard Street, Vancouver, British Columbia V6Z 1Y6, Canada.
Objectives The aim of this study was to examine the effect of different transcatheter heart valves (THVs) on valve leaflet displacement when deployed within bioprosthetic surgical valves and, thereby, risk for coronary obstruction.
Background Coronary obstruction is a potentially devastating complication during valve-in-valve (ViV) transcatheter aortic valve replacement. Strategies such as provisional stenting and intentional bioprosthetic valve leaflet laceration have been developed to mitigate this risk. Alternatively, the use of a THV that retracts the bioprosthetic leaflet away from the coronary ostium may prevent coronary obstruction.
Methods A 25-mm J-Valve, a 26-mm Evolut Pro, and a 23-mm JenaValve were implanted into both a 25-mm Trifecta surgical valve and a 25-mm Mitroflow surgical valve. A 23-mm and a 26-mm SAPIEN 3 were deployed into the Trifecta and Mitroflow, respectively. Displacement of the surgical valve leaflets (retraction vs. expansion) was measured with implantation of each THV by measuring displacement angle and maximal displacement distance.
Results Within both the Trifecta and Mitroflow valves, implantation of the J-Valve and JenaValve resulted in retraction of the surgical valve leaflets, and placement of the Evolut Pro and SAPIEN 3 resulted in tubular expansion of the surgical valve leaflets. There were significant differences in displacement angles and distances between both the J-Valve and JenaValve and the SAPIEN 3 and Evolut Pro (p < 0.0001).
Conclusions ViV implantation with new-generation THVs that directly interact with bioprosthetic valve leaflets results in surgical valve leaflet retraction. This might mitigate the risk for coronary obstruction in selected cases of ViV transcatheter aortic valve replacement and also facilitate coronary reaccess after ViV TAVR.
Dr. Sellers is supported by a fellowship from the Michael Smith Foundation for Health Research and the Canadian Institutes of Health Research. Dr. Sathananthan has received speaking fees from and is a consultant to Edwards Lifesciences. Dr. Cheung is a consultant to Abbott Vascular, Medtronic, and Neovasc. Dr. Wood is a consultant to Edwards Lifesciences. Dr. Blanke is a consultant to Edwards Lifesciences. Dr. Leipsic is a consultant to Edwards Lifesciences; and provides computed tomography core laboratory services for Edwards Lifesciences, Medtronic, Neovasc, and Tendyne Holdings, for which no direct compensation is received. Dr. Ye is a consultant to Edwards Lifesciences and JC Medical. Dr. Webb is a consultant to and has received research funding from Edwards Lifesciences, Abbott Vascular, Boston Scientific, and Vivitro Medical. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received August 1, 2019.
- Revision received October 4, 2019.
- Accepted October 8, 2019.
- 2020 American College of Cardiology Foundation
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