Transcatheter Valve-in-Valve Intervention within the Trifecta Aortic Valve
Lankenau, Wynnewood, PA, USA.
Background: The objective of this work is to evaluate the safety and efficacy of performing a transcatheter valve-in-valve intervention within the Trifecta valve.
Methods: As part of a multicenter, prospective, nonrandomized, long-term follow-up study 710 patients underwent surgical aortic valve replacement between 2007 and 2009 with the Trifecta valve. Over 10 years of follow-up a total of 32 patients underwent transcatheter valve-in-valve intervention.
Results: Between 2013 and 2018, 32 patients underwent transcatheter valve-in-valve intervention (78% males, mean age at the time of the event leading to valve-in-valve: 74.8 ± 7.7 years). Implanted Trifecta valve sizes consisted of 21mm (7), 23mm (16), 25mm (6), 27mm (2), and 29mm (1). The indication for valve-in-valve intervention was structural valve deteriorations in all cases. Valve-in-valve procedural data was obtained in 27 subjects. The transcatheter valve-in-valve intervention occurred 8.3 ± 1.3 years after surgical implant (range, 5.4 to 10.1 years). Transcatheter valve utilized consisted of Sapien (12/27), CoreValve (13/25), Portico (1/25), and Symetis Acurate Neo (1/27). Balloon valvuloplasty was successfully performed post-implantation in 3 cases (11%). Overall success rate was 100% with no reports of coronary artery obstruction and post-procedural survival was 100%. Mean transvalvular gradient prior to valve-in-valve intervention was 31.7 ± 14 mmHg (n = 25) and following valve-in-valve intervention was 15.6 ± 7.6 mmHg (n = 26).
Conclusion: These results demonstrate that valve-in-valve may be performed safely and effectively within Trifecta™ valve using self-expanding or balloon expandable transcatheter valves.
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