Thorac Cardiovasc Surg 2017; 65(03): 225-230
DOI: 10.1055/s-0036-1586492
Original Cardiovascular
Georg Thieme Verlag KG Stuttgart · New York

Hemodynamic Performance of Endovascular Valves as Valve-in-Valve in Small Stented Bioprosthesis

Ralf-Uwe Kuehnel
1   Department of Cardiovascular Surgery, Immanuel Klinikum Bernau Heart Center, Brandenburg University Hospital, Brandenburg Medical School, Bernau, Germany
,
Martin Hartrumpf
1   Department of Cardiovascular Surgery, Immanuel Klinikum Bernau Heart Center, Brandenburg University Hospital, Brandenburg Medical School, Bernau, Germany
,
Michael Erb
1   Department of Cardiovascular Surgery, Immanuel Klinikum Bernau Heart Center, Brandenburg University Hospital, Brandenburg Medical School, Bernau, Germany
,
Johannes M. Albes
1   Department of Cardiovascular Surgery, Immanuel Klinikum Bernau Heart Center, Brandenburg University Hospital, Brandenburg Medical School, Bernau, Germany
› Author Affiliations
Further Information

Publication History

24 January 2016

20 June 2016

Publication Date:
12 August 2016 (online)

Abstract

Background Endovascular valve in stented biological valve implantation (valve-in-valve transcatheter aortic valve implantation [TAVI ViV]) is increasingly becoming a valid option for bioprosthesis degeneration. TAVI implantation in small stented biological valves below 23 mm is controversially discussed. Reduced opening area and high gradients are typical objections against this procedure in cases of small bioprosthesis. Systematic studies about the hemodynamic performance of endovascular valves in small stented bioprosthesis, however, do not exist.

Methods Stented biological valves of 21 mm size were analyzed in a pulse duplicator (cardiac output 4.9 L/min). Edwards Perimount Magna (EP; Edwards Lifesciences, Irvine, California, United States), Medtronic Mosaic (MM; Medtronic Inc., Minneapolis, Minnesota, United States), and Sorin Mitroflow (SM; Milan, Italy) were investigated (three valves, each type). Mean transvalvular gradients were measured before and after implantation of Edwards Sapien 23 mm (SAP) as ViV.

Results There were no marked differences of mean transvalvular gradients before and after ViV (EP21: 12.3 mm Hg; EP21 + SAP: 11.1 mm Hg; SM21: 13.5 mm Hg; SM21 + SAP: 14.9 mm Hg; MM21: 21.4 mm Hg; MM21 + SAP: 15.1 mm Hg). MM valves fabricated from porcine cusps showed higher initial gradients in contrast to valves constructed with pericardium (EP and SM). After ViV, however, this difference was reduced.

Conclusion This in vitro study shows that hemodynamic performance of endovascular valves as ViV in small bioprosthesis does not differ significantly from the performance of the initial implanted prosthesis. Hemodynamic performance of porcine cusp valves could even be optimized. It can thus be speculated that TAVI ViV also offers a reasonable option for patients with typical stented bioprosthetic degeneration to substantially prolong adequate function with one initial surgical and one consecutive interventional procedure even in small valves.

 
  • References

  • 1 Azadani AN, Jaussaud N, Ge L, Chitsaz S, Chuter TA, Tseng EE. Valve-in-valve hemodynamics of 20-mm transcatheter aortic valves in small bioprostheses. Ann Thorac Surg 2011; 92 (2) 548-555
  • 2 Ferrari E. Transcatheter aortic “valve-in-valve” for degenerated bioprostheses: Choosing the right TAVI valve. Ann Cardiothorac Surg 2012; 1 (2) 260-262
  • 3 Ferrari E, Marcucci C, Sulzer C, von Segesser LK. Which available transapical transcatheter valve fits into degenerated aortic bioprostheses?. Interact Cardiovasc Thorac Surg 2010; 11 (1) 83-85
  • 4 Webb JG, Wood DA, Ye J , et al. Transcatheter valve-in-valve implantation for failed bioprosthetic heart valves. Circulation 2010; 121 (16) 1848-1857
  • 5 Walther T, Falk V, Borger MA , et al. Transapical aortic valve implantation in patients requiring redo surgery. Eur J Cardiothorac Surg 2009; 36 (2) 231-234 , discussion 234–235
  • 6 Tillquist MN, Maddox TM. Cardiac crossroads: deciding between mechanical or bioprosthetic heart valve replacement. Patient Prefer Adherence 2011; 5: 91-99
  • 7 Niclauss L, von Segesser LK, Ferrari E. Aortic biological valve prosthesis in patients younger than 65 years of age: transition to a flexible age limit?. Interact Cardiovasc Thorac Surg 2013; 16 (4) 501-507
  • 8 Dvir D, Webb J, Brecker S , et al. Transcatheter aortic valve replacement for degenerative bioprosthetic surgical valves: results from the global valve-in-valve registry. Circulation 2012; 126 (19) 2335-2344
  • 9 Jategaonkar SR, Scholtz W, Horstkotte D, Gummert J, Ensminger SM, Börgermann J. Transfemoral aortic valve-in-valve implantation with the CoreValve Evolut for small degenerated stented bioprosthesis. J Invasive Cardiol 2014; 26 (6) 291-294
  • 10 Kuehnel RU, Puchner R, Pohl A , et al. Characteristic resistance curves of aortic valve substitutes facilitate individualized decision for a particular type. Eur J Cardiothorac Surg 2005; 27 (3) 450-455 , discussion 455
  • 11 Pohl M, Meyer R, Kühnel R, Talukder NK, Wendt MO. Different types of aortic stenosis and simulation of their morphological-hydrodynamic interdependence—in vitro study with allografts and stenotic valve models. Int J Artif Organs 2001; 24 (12) 870-877
  • 12 Wendt MO, Pohl M, Werner S, Kühnel R, Toppel D. Differentiated evaluation of heart valve stenosis by expanded Bernoulli equation—in vitro studies of model stenoses [in German]. Z Kardiol 1995; 84 (9) 686-693
  • 13 Higashidate M, Tamiya K, Beppu T, Imai Y. Regulation of the aortic valve opening. In vivo dynamic measurement of aortic valve orifice area. J Thorac Cardiovasc Surg 1995; 110 (2) 496-503
  • 14 Scotten LN, Walker DK. New laboratory technique measures projected dynamic area of prosthetic heart valves. J Heart Valve Dis 2004; 13 (1) 120-132 , discussion 132–133
  • 15 Schichl K, Affeld K. A computer controlled versatile pulse duplicator for precision testing of artificial heart valves. Int J Artif Organs 1993; 16 (10) 722-728
  • 16 International Organization for Standardization (ISO). Cardiovascular Implants—Cardiac Valve Prostheses. Revision of 3rd edition 2003; 14-16
  • 17 FDA. Test Protocol: Interlaboratory Comparison of Prosthetic Heart Valve Performance Testing. Rockville, Maryland: FDA; 1985
  • 18 Werner S, Wendt MO, Schichl K, Pohl M, Koch B. Testing the hydrodynamic properties of heart valve prostheses with a new test apparatus [in German]. Biomed Tech (Berl) 1994; 39 (9) 204-210
  • 19 Pohl M, Wendt MO, Werner S, Koch B, Lerche D. In vitro testing of artificial heart valves: comparison between Newtonian and non-Newtonian fluids. Artif Organs 1996; 20 (1) 37-46
  • 20 Dumesnil JG, Yoganathan AP. Valve prosthesis hemodynamics and the problem of high transprosthetic pressure gradients. Eur J Cardiothorac Surg 1992; 6 (Suppl. 01) S34-S37 , discussion S38
  • 21 Chiang YP, Chikwe J, Moskowitz AJ, Itagaki S, Adams DH, Egorova NN. Survival and long-term outcomes following bioprosthetic vs mechanical aortic valve replacement in patients aged 50 to 69 years. JAMA 2014; 312 (13) 1323-1329
  • 22 Albes JM, Hartrumpf M, Rudolph V , et al. Are mechanical valves with enhanced inner diameter advantageous in the small sized aortic annulus?. Ann Thorac Surg 2003; 76 (5) 1564-1570 , discussion 1570
  • 23 Brennan JM, Edwards FH, Zhao Y , et al; DEcIDE AVR (Developing Evidence to Inform Decisions about Effectiveness–Aortic Valve Replacement) Research Team. Long-term safety and effectiveness of mechanical versus biologic aortic valve prostheses in older patients: results from the Society of Thoracic Surgeons Adult Cardiac Surgery National Database. Circulation 2013; 127 (16) 1647-1655
  • 24 Zeitani J, Bertoldo F, Nardi P , et al. Influence of patient-prosthesis mismatch on myocardial mass regression and clinical outcome in physically active patients after aortic valve replacement. J Heart Valve Dis 2004; 13 (Suppl. 01) S63-S67
  • 25 Stassano P, Di Tommaso L, Monaco M , et al. Aortic valve replacement: a prospective randomized evaluation of mechanical versus biological valves in patients ages 55 to 70 years. J Am Coll Cardiol 2009; 54 (20) 1862-1868
  • 26 Hartrumpf M, Kuehnel R, Erb M, Loladze G, Mueller T, Albes J. Favorable gradients with the mitroflow aortic valve prosthesis in everyday surgery. Thorac Cardiovasc Surg 2012; 60 (5) 326-333 , discussion 333–334
  • 27 Dvir D, Webb JG, Bleiziffer S , et al; Valve-in-Valve International Data Registry Investigators. Transcatheter aortic valve implantation in failed bioprosthetic surgical valves. JAMA 2014; 312 (2) 162-170
  • 28 Jategaonkar SR, Dimitriadis Z, Hakim-Meibodi K, Gummert J, Horstkotte D, Scholtz W. Delayed coronary ischemia after transfemoral aortic valve implantation. J Heart Valve Dis 2013; 22 (6) 762-766