TY - JOUR JO - EuroIntervention TI - A bench test study of bioprosthetic valve fracture performed before versus after transcatheter valve-in-valve intervention AB - <p><strong>Aims:</strong> Bioprosthetic valve fracture (BVF) may improve transvalvular gradients and transcatheter heart valve (THV) expansion during VIV interventions. However, the optimal timing of BVF is unknown. We assessed the impact of timing of BVF (before versus after) for valve-in-valve (VIV) intervention, on hydrodynamic function and THV expansion.</p> <p><strong>Methods and results:</strong> Three THV designs were assessed, a 23 mm SAPIEN 3 (S3), small ACURATE <em>neo</em> (ACn) and 23 mm Evolut R, deployed into 21 mm Mitroflow bioprosthetic surgical valves. We evaluated each THV in three groups: 1) no BVF, 2) BVF before VIV, and 3) BVF after VIV. Hydrodynamic testing was performed using a pulse duplicator to ISO 5840:2013 standard. Transvalvular gradients were lower when BVF was performed after VIV for the S3 (no BVF 15.5 mmHg, BVF before VIV 8.0 mmHg, BVF after VIV 5.6 mmHg), and the ACn (no BVF 9.8 mmHg, BVF before VIV 8.4 mmHg, BVF after VIV 5.1 mmHg). Transvalvular gradients were similar for the Evolut R, irrespective of performance of BVF or timing of BVF. BVF performed after VIV resulted in better expansion in all three THV designs. The ACn and Evolut R samples all had a mild degree of pinwheeling, and BVF timing did not impact on pinwheeling severity. The S3 samples had severe pinwheeling with no BVF, and significant improvement in pinwheeling when BVF was performed after VIV.</p> <p><strong>Conclusions:</strong> BVF performed after VIV was associated with superior THV expansion in all three THV designs tested, with lower residual transvalvular gradients in the S3 and ACn THVs. The Evolut R had similar hydrodynamic performance irrespective of BVF timing. Timing of BVF has potential implications on THV function.</p> AU - Sathananthan Janarthanan AU - Fraser Rob AU - Hatoum Hoda AU - Barlow M. Aaron AU - Stanová Viktória AU - Allen B. Keith AU - Chhatriwalla K. Adnan AU - Rieu Régis AU - Pibarot Philippe AU - Dasi Prasad Lakshmi AU - Søndergaard Lars AU - Wood David A. AU - Webb John G. VL - 15 IS - 16 Y1 - 20/03/2020 Y1 - 2020 DOI - 10.4244/EIJ-D-19-00939 SP - 1409 EP - 1416 KW - aortic stenosis KW - balloon valvuloplasty KW - valve restenosis KW - valve-in-valve PB - Europa Digital & Publishing SE - Interventions for valvular disease and heart failure UR - https://eurointervention.pcronline.com/article/bioprosthetic-valve-fracture-performed-before-versus-after-valve-in-valve-intervention-insights-from-bench-testing SN - 1774-024X ER -