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المؤلفون: Keith B. Allen, Adnan K. Chhatriwalla, John T. Saxon, David J. Cohen, Tom C. Nguyen, John Webb, Pranav Loyalka, Anthony A. Bavry, Joshua D. Rovin, Brian Whisenant, Danny Dvir, Kevin F. Kennedy, Vinod Thourani, Richard Lee, Sanjeev Aggarwal, Suzanne Baron, Anthony Hart, J. Russell Davis, A. Michael Borkon, Sathananthan Janarthanan, Thomas Beaver, Ashkan Karimi, Dennis Gory, Lang Lin, Douglas Spriggs, John Ofenloch, Abhijeet Dhoble, Brian Hummel, Mark Russo, Bruce Haik, Michael Lim, Vasilis Babaliaros, Adam Greenbaum, William O'Neill, Juhana Karha, D.W. Park, Ed Garrett, Alex Pak, Zafir Hawa, James Mitchell, Axel Unbehaun, Anwar Tandar, Pradeep Yadav, Jason Ricci, Alan Yeung
المصدر: The Journal of Thoracic and Cardiovascular Surgery. 158:1317-1328.e1
مصطلحات موضوعية: Balloon Valvuloplasty, Male, Reoperation, Pulmonary and Respiratory Medicine, medicine.medical_specialty, Transcatheter aortic, medicine.medical_treatment, Aortic root, Hemodynamics, 030204 cardiovascular system & hematology, Prosthesis Design, Balloon, Transcatheter Aortic Valve Replacement, Bioprosthetic valve, 03 medical and health sciences, 0302 clinical medicine, Valve replacement, Interquartile range, Internal medicine, medicine, Humans, Aged, Aged, 80 and over, Bioprosthesis, business.industry, Aortic Valve Stenosis, United States, Prosthesis Failure, Outcome and Process Assessment, Health Care, 030228 respiratory system, Multicenter study, Aortic Valve, Heart Valve Prosthesis, Cardiology, Female, Surgery, Cardiology and Cardiovascular Medicine, business
الوصف: Valve-in-valve transcatheter aortic valve replacement (VIV TAVR) can result in high residual gradients that are associated with increased mortality. Bioprosthetic valve fracture (BVF) has been shown to improve residual gradients following VIV TAVR; however, factors influencing the results of BVF have not been studied.BVF was performed in 75 patients at 21 centers. Hierarchical multiple linear regression was performed to identify variables that were associated with lower final transvalvular gradient.Surgical valves with a median true internal diameter of 18.5 mm (interquartile range, 17.0-20.5 mm) were treated with VIV TAVR in conjunction with BVF using balloon-expandable (n = 43) or self-expanding (n = 32) transcatheter heart valves with a median size of 23 mm (interquartile range, 23-23 mm). There were no aortic root disruptions, coronary occlusions, or new pacemakers; in-hospital or 30-day mortality was 2.6% (2 out of 75). Final mean transvalvular gradient was 9.2 ± 6.3 mm Hg, but was significantly lower when BVF was performed after VIV TAVR compared with BVF first (8.1 ± 4.8 mm Hg vs 16.9 ± 10.1 mm Hg; P .001). After adjusting for timing of BVF (ie, before or after VIV TAVR), transcatheter heart valve size/type, surgical valve mode of failure, true internal diameter, and baseline gradient and BVF balloon size, performing BVF after VIV TAVR (P .001) and using a larger BVF balloon (P = .038) were the only independent predictors of lower final mean gradient.BVF can be performed safely and results in reduced residual transvalvular gradients. Performing BVF after VIV TAVR and using larger balloon appears to achieve the best hemodynamic results.