Journal article

Publication year: 2022

Pages: 77-82

Journal: International Journal of Cardiology

Volume number: 358

ISSN: 0167-5273

eISSN: 1874-1754

DOI Link: https://doi.org/10.1016/j.ijcard.2022.04.031

Publisher: Elsevier

Abstract: 

Objectives: Malpositioning of transcatheter heart valves increases the risk of procedural failure. For the ACURATE system, inadvertent movement of the prosthesis to a varying extent is sometimes observed upon full release, but the incidence, mechanisms, and clinical impact of such valve micro-dislodgement (VMD) are poorly understood. The aim of the present study was to assess the incidence, predictors, and clinical outcomes of VMD in an all-comers population that underwent transcatheter aortic valve implantation (TAVI) with the ACURATE neo2 prosthesis (NEO2).

Methods: This was a retrospective analysis of 448 consecutive patients who underwent transfemoral TAVI with NEO2 at our institution. VMD was defined as displacement >= 2 mm between the initial position and immediately after valve release as measured on fluoroscopy at the non-coronary cusp. The initial valve position prior to step 2 was categorized using the radiopaque marker band (RMB) relative to the annular plane. In addition, further anatomical and procedural characteristics were assessed.

Results: A total of 68 (15.2%) cases with VMD were identified. A larger cover index, higher RMB position, partial detachment of the lower crown, and severe parallax prior to deployment were independent predictors of VMD, whereas a position of the delivery system in the outer curvature was protective against VMD. Among patients with VMD, the rates of valvular malpositioning and thus technical failure (VARC-3) were higher, but mean transprosthetic gradients were lower.

Conclusions: VMD occurs in a notable proportion of transfemoral TAVI cases with NEO2 and is associated with more frequent technical failure of the procedure.

Harvard Citation style: Kim, W., Renker, M., Doerr, O., Nef, H., Fischer-Rasokat, U., Choi, Y., et al. (2022) Micro-dislodgement of a self-expanding transcatheter heart valve: Incidence, predictors, and outcomes, International Journal of Cardiology, 358, pp. 77-82. https://doi.org/10.1016/j.ijcard.2022.04.031

APA Citation style: Kim, W., Renker, M., Doerr, O., Nef, H., Fischer-Rasokat, U., Choi, Y., Hamm, C., & Charitos, E. (2022). Micro-dislodgement of a self-expanding transcatheter heart valve: Incidence, predictors, and outcomes. International Journal of Cardiology. 358, 77-82. https://doi.org/10.1016/j.ijcard.2022.04.031