B-61 | Incidence of Patient Prosthesis Mismatch (PPM) After ViV-TAVI and ViV-TAVI With Bioprosthetic Valve Fracture (BVF)

Abstract

Valve-in-valve (ViV) transcatheter aortic valve implantation (TAVI) is an effective treatment for degenerated bioprosthetic valves in high-risk patients. Unfortunately, patient prosthesis mismatch (PPM) remains an issue. PPM is known to impact functional status, valve longevity, morbidity and mortality. Bioprosthetic valve fracturing (BVF) is a method by which operators fracture the bioprosthetic valve allowing for greater expansion of the new valve or implantation of a larger valve. We sought to determine the incidence of PPM in patients undergoing ViV-TAVI and the safety of BVF. Patients who underwent ViV-TAVI at our institution from 2015-2022 were selected and divided into two groups (with BVF and without BVF). BVF was performed at the discretion of the operator. PPM severity was assessed as insignificant, moderate or severe. Moderate PPM was defined as an indexed effective orifice area (iEOA) <0.85 cm2/m2 (if BMI<30 kg/m2) or <0.70 cm2/m2 (if BMI>30 kg/m2). Severe PPM was defined as an iEOA <0.65 cm2/m2 (if BMI<30 kg/m2) or <0.55 cm2/m2 (if BMI>30 kg/m2). Measurements were taken by TTE on post operative day 1. All-cause mortality was assessed at 30-days and at 1-year. A total of 78 patients underwent ViV-TAVI, of which 25 patients had suboptimal gradients and were successfully treated with BVF. The mean age was 76.71 years old. The overall mean iEOA post ViV-TAVI was 0.69 ± 0.20 cm2/m2. Severe PPM was present in 43.4% that underwent ViV-TAVI, while only in 16% of patients that underwent ViV-TAVI with BVF. 1 patient required a permanent pacemaker in the BVF group. Amongst patients who underwent ViV-TAVI, 96.2% of patients were living at 30-days and 90.6% of patients were living at 1-year. Amongst patients who underwent ViV-TAVI with BVF, 100% of patients were living at 30-days and 96% of patients were living at 1-year. PPM was present more often in ViV-TAVI patients compared to ViV-TAVI with BVF. Short term mortality appears to be similar between groups and complications rates are low.