Structural
Valve-in-Valve Implantation Using the ACURATE Neo in Degenerated Aortic Bioprostheses: An International Multicenter Analysis

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Abstract

Objectives

This study reports an international experience using the transfemoral ACURATE neo transcatheter heart valve (Boston Scientific, Marlborough, Massachusetts) for the treatment of degenerated surgical aortic bioprostheses.

Background

Transcatheter valve-in-valve procedures have emerged as an alternative to redo surgery. Supra-annular prostheses might be particularly useful in this indication.

Methods

This is an international multicenter analysis including 85 patients from 14 centers in Europe and Canada undergoing an ACURATE neo valve-in-valve procedure from March 2015 to February 2019.

Results

Internal diameter of the degenerated bioprosthesis was 20.3 ± 2.1 mm. Prosthesis size S was used in 70 (82%) procedures. The median depth of implantation was 3 mm and the upper crown of the ACURATE neo was positioned above the stent posts of the degenerated bioprosthesis in 54 (64%) and inside in 31 (36%). Mean transvalvular gradient before discharge was significantly lower if the upper crown was above the degenerated bioprosthesis (13.7 ± 5.9 mm Hg vs. 19.5 ± 10.0 mm Hg; p = 0.001). However, a high position of the ACURATE neo resulted in embolization in 1 patient, conversion to open-heart surgery in 1, and need for reintervention due to transcatheter heart valve failure within the first 18 months of follow-up in 4.

Conclusions

This early experience shows that a high implantation of the ACURATE neo with the upper crown above the stent posts of the degenerated bioprosthesis resulted in lower mean transvalvular gradients but a higher rate of malpositioning and early valve degeneration.

Key Words

degenerated bioprosthesis
transcatheter aortic valve implantation
transcatheter aortic valve replacement
transfemoral
valve-in-valve

Abbreviations and Acronyms

AVA
aortic valve area
ID
inner diameter
PPM
prosthesis-patient mismatch
THV
transcatheter heart valve
ViV
valve-in-valve

Cited by (0)

Drs. Holzamer and Hilker have served as proctors for and received research grant support from Boston Scientific. Dr. Kim has served as a proctor for Boston Scientific, Abbott, and Edwards Lifesciences; and has received speaker fees from Edwards Lifesciences, Abbott, Medtronic, and Symetis/Boston Scientific. Dr. Rück has received lecture fees from Boston Scientific and Edwards Lifesciences; and has received research grant support from Boston Scientific. Dr. Sathananthan has served as a consultant for Edwards Lifesciences. Drs. Amat-Santos, Husser, and Stella have served as a proctor for Boston Scientific. Dr. Pellegrini has received minor travel grants from Boston Scientific and Edwards Lifesciences. Dr. Castriota has served as a proctor and consultant for Boston Scientific; and has served as a consultant for Medtronic, Abbott, and Terumo. Dr. Webb is a consultant to, and has received research funding from, Edwards Lifesciences, Abbott, and ViVitro Labs; and is a proctor for Boston Scientific. Dr. Nietlispach has served as a consultant for Edwards Lifesciences, Abbott Vascular, and Medtronic. Dr. Toggweiler has served as a proctor and consultant for Boston Scientific and New Valve Technology; and has received an institutional research grant from Boston Scientific. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.