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Prosthesis Infolding Incidence and Short-Term Outcomes in Transcatheter Aortic Valve Implantation Using Evolut

Andrea Bezzeccheri1, Enrico Poletti2, Paul Vermeersch2

  • 1HartCentrum, Ziekenhuis Netwerk Antwerpen (ZNA) Middelheim, Antwerp, Belgium; Department of Experimental Medicine, University of Rome "Tor Vergata", Rome, Italy.

The American Journal of Cardiology
|April 18, 2024
PubMed
Summary

Prosthesis infolding during transcatheter aortic valve implantation (TAVI) is a rare complication. This complication is linked to increased mortality and adverse outcomes, highlighting the need for prompt diagnosis and management.

Keywords:
VARC-3infoldingoutcomestranscatheter aortic valve implantation

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Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Medical Device Technology

Background:

  • Transcatheter aortic valve implantation (TAVI) is a key treatment for aortic valve disease.
  • Infolding, a specific complication of self-expandable TAVI prostheses, involves nonuniform expansion.
  • Understanding infolding is crucial for improving TAVI safety and patient outcomes.

Purpose of the Study:

  • To determine the incidence, predictors, management strategies, and outcomes of infolding with the Medtronic Evolut TAVI system.
  • To analyze the impact of infolding on periprocedural characteristics and short-term clinical outcomes.

Main Methods:

  • A multicenter, observational, retrospective study included 1,470 patients undergoing Medtronic Evolut TAVI between January 2018 and March 2022.
  • Patients were divided into two groups based on the occurrence of infolding.
  • Periprocedural data and 30-day outcomes were compared between groups.

Main Results:

  • The incidence of infolding was 1.6% (23 cases).
  • Infolding was associated with larger aortic anatomy, greater calcification, use of Evolut Pro+ (34 mm), and resheathing maneuvers.
  • Infolding cases showed higher rates of moderate-to-severe paravalvular regurgitation, all-cause mortality, cardiovascular mortality, and pacemaker implantation.

Conclusions:

  • Prosthesis infolding is an infrequent but serious TAVI complication associated with worse cardiovascular outcomes.
  • High right cusp calcium score and resheathing maneuvers are independent predictors of infolding.
  • Prompt intraprocedural diagnosis and management, including prosthesis recapture or postdilation, are essential for mitigating this complication.