Transcatheter Aortic Valve Replacement for Failed Surgical Bioprostheses: Insights from the PARTNER II Valve-in-Valve Registry on Utilizing Baseline Computed-Tomographic Assessment

Abstract

ABSTRACTBackground: Residual stenosis is a major limitation of transcatheter aortic valve replacement inside failed surgical bioprostheses (valve-in-valve). Our aim was to evaluate whether pre-procedure CT assessment could identify cases at risk for having residual stenosis after the procedure.Methods: Patients with failed surgical aortic bioprostheses were prospectively enrolled in the multicenter PARTNER II valve-in-valve registry. Core-lab assessment of echocardiographic and CT findings were utilized.Results: A total of 84 patients that underwent pre-procedural CT were included in the current analysis with a median age of 79.9 ± 9.6 years with 65.5% being male. CT average annulus internal area was 331.64 ± 73.52mm2. Post SAPIEN XT implantation mean gradient was 17.95 ± 7.59 mmHg and average aortic valve area was 1.06 ± 0.35 cm2. Small internal annular area per CT was significantly associated with increased gradients in intermediate/large surgical valves (true ID > 20 mm, p = 0.01). ROC curve for the evaluation of predictability of CT measured area on post-procedural gradients in intermediate/large surgical valves was high (AUC 0.81). Cutoff of 329 mm2 had negative predictive value of 95%.Conclusions: CT-derived annulus area in cases with intermediate and large surgical valves can identify cases at risk for poor hemodynamics after valve-in-valve and influence clinical decision making.