Bioprosthetic valve fracture: Technical insights from a multicenter study

Area of Science:

• Cardiology
• Interventional Cardiology
• Biomedical Engineering

Background:

• High residual gradients after valve-in-valve transcatheter aortic valve replacement (VIV TAVR) are linked to increased mortality.
• Bioprosthetic valve fracture (BVF) is a technique to reduce these gradients, but factors influencing its success are not well understood.

Purpose of the Study:

• To identify factors associated with reduced final transvalvular gradients after Bioprosthetic valve fracture (BVF) during valve-in-valve transcatheter aortic valve replacement (VIV TAVR).

Main Methods:

• A hierarchical multiple linear regression analysis was performed on data from 75 patients undergoing VIV TAVR with BVF across 21 centers.
• Patient data included surgical valve characteristics, transcatheter heart valve details, and gradient measurements before and after the procedure.

Main Results:

• Performing BVF after VIV TAVR resulted in significantly lower final mean transvalvular gradients (8.1 ± 4.8 mm Hg) compared to performing BVF first (16.9 ± 10.1 mm Hg).
• Using a larger BVF balloon was also an independent predictor of lower final mean gradient (P = .038).
• No aortic root disruptions, coronary occlusions, or new pacemakers were reported; in-hospital or 30-day mortality was 2.6%.

Conclusions:

• Bioprosthetic valve fracture (BVF) is a safe procedure that effectively reduces residual transvalvular gradients in VIV TAVR.
• The optimal approach involves performing BVF after VIV TAVR, utilizing a larger balloon to achieve the best hemodynamic results.