Which Prosthesis For Valve-in-valve-in-valve Therapy?
Doreen Richardt, Franziska Halm, Sina Stock, Michael Scharfschwerdt, Hans-Hinrich Sievers.
University Hospital Schleswig-Holstein, Campus Luebeck, Luebeck, Germany.
Objective: Valve-in-Valve-in-Valve therapy (ViViV) is a treatment strategy for degenerated aortic valve prostheses after implanting a TAVI-prosthesis as a Valve-in-Valve-procedure (ViV), but there is some concern regarding patient prosthesis mismatch. Methods We constructed aortic root models with both, Trifecta bioprosthesis (Size 21 and 25) and Perimount Magna Ease Bioprosthesis (size 21 and 23) and inserted a Corevalve Evolut R Medtronic (size 23, 26 resp. 31) or Sapien XT and S3 Edwards (size 23 resp.26) TAVI prosthesis as ViV. Thereafter ViViV-procedure was simulated by implanting again a Corevalve Evolut R Medtronic (size 23, 26 resp. 31) or Sapien XT and S3 Edwards (size 23 resp.26). Hemodynamic performance (transvalvular gradients and geometric orifice area) was measured before ViV, after ViV and after ViViV. Results There was no difference in transvalvular gradients and geometric orifice area between Trifecta and Perimount Magna Ease bioprostehses. Transvalvular gradients were significantly greater and geometric orifice areas were significantly smaller in ViViV with CoreValve prostheses. Comparing Edwards Sapien XT and S3 prostheses, transvalvular gradients were significantly greater and geometric orifice area was significantly smaller in S3 prostheses. Conclusion Hemodynamics were influenced significantly by ViV and ViViV procedure. Corevalve prostheses seem to have inferior properties for ViViV-procedures than Edwards Sapien XT and S3 bioprostheses. S3-prostheses had significantly greater transvalvular gradients and smaller geometric orifice areas than the XT-prostheses. Overall Sapien XT prostheses seem to have beneficial properties for ViViV-procedures.
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