Bioprosthetic Valve Fracturing in Valve-in-Valve TAVI: Clinical and Echocardiographic Outcomes in Failing Perimount Aortic Bioprostheses-A Multicenter Registry

Hendrik Ruge; Melchior Burri; Julia Schreyer; Teodora-Cristiana Georgescu; Derk Frank; Won-Keun Kim; Ole de Backer; Martin Beyer; Andreas Schäfer; Chiara Fraccaro; Giuseppe Tarantini; Erion Xhepa; Michael Joner; Markus Krane; Héctor Alfonso Alvarez Covarrubias

doi:10.1002/ccd.31686

Bioprosthetic Valve Fracturing in Valve-in-Valve TAVI: Clinical and Echocardiographic Outcomes in Failing Perimount Aortic Bioprostheses-A Multicenter Registry

Hendrik Ruge^*, Melchior Burri, Julia Schreyer, Teodora-Cristiana Georgescu, Derk Frank, Won-Keun Kim, Ole de Backer, Martin Beyer, Andreas Schäfer, Chiara Fraccaro, Giuseppe Tarantini, Erion Xhepa, Michael Joner, Markus Krane, Héctor Alfonso Alvarez Covarrubias

^*Corresponding author af dette arbejde

Afdeling for Hjertesygdomme HJE

2 Citationer (Scopus)

Abstract

BACKGROUND: Data comparing clinical and hemodynamic outcomes of bioprosthetic valve fracturing (BVF) and "standard"-postdilatation during valve-in-valve transcatheter heart valve implantation (ViV-TAVI) are lacking. The authors aimed to analyze hemodynamic and clinical outcomes of BVF compared to "standard"-postdilatation during ViV-TAVI.

METHODS: The REDUCE registry included patients who underwent ViV-TAVI within a Perimount surgical aortic valve bioprosthesis (Edwards Lifesciences, USA). Procedures were categorized to no postdilatation, "standard"-postdilatation and BVF. Hemodynamic and clinical outcomes at 30 days were collected and compared. A linear regression model was built to predict mean aortic gradient after ViV-TAVI.

RESULTS: A total of 240 patients from six European sites were included. Median age was 78 years [IQR 70; 83], logistic EuroSCORE calculated 20.0%[IQR 12.2; 33.1] and 159 patients (66%) were male. One hundred fourty-four Perimount valves (60%) had a true internal diameter (ID) ≤ 21 mm. Self-expanding valves (SEV) and ballon-expandable valves (BEV) were used in 60% and 40% of cases, respectively. One hundred sixteen procedures (48%) were executed without postdilatation, in 88 procedures (37%) "standard"-postdilatation and in 36 procedures (15%) BVF was used. 30-day survival was 93.3%. VARC-3 device success at 30 days was 71%. A multivariable regression analysis of the mean aortic gradient after ViV-TAVI showed a significant association with surgical valve size (-0.84 mmHg, p = 0.001; per 1 mm surgical valve size increase), execution of postdilatation (-3.25 mmHg, p = 0.007) and type of transcatheter heart valve (SEV: -7.31 mmHg, p < 0.001).

CONCLUSIONS: When performing ViV-TAVI within a Perimount surgical aortic bioprosthesis with a true ID ≤ 21 mm, the hemodynamic valve performance is most optimal when implanting a SEV-TAV and when postdilating the TAV-in-SAV complex. BVF did not result in superior hemodynamics compared to "standard"-postdilatation.

Originalsprog	Engelsk
Tidsskrift	Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions
Vol/bind	106
Udgave nummer	2
Sider (fra-til)	1409-1420
Antal sider	12
ISSN	1522-1946
DOI	https://doi.org/10.1002/ccd.31686
Status	Udgivet - aug. 2025

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Ruge, H., Burri, M., Schreyer, J., Georgescu, T.-C., Frank, D., Kim, W.-K., de Backer, O., Beyer, M., Schäfer, A., Fraccaro, C., Tarantini, G., Xhepa, E., Joner, M., Krane, M., & Covarrubias, H. A. A. (2025). Bioprosthetic Valve Fracturing in Valve-in-Valve TAVI: Clinical and Echocardiographic Outcomes in Failing Perimount Aortic Bioprostheses-A Multicenter Registry. Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions, 106(2), 1409-1420. https://doi.org/10.1002/ccd.31686

Bioprosthetic Valve Fracturing in Valve-in-Valve TAVI: Clinical and Echocardiographic Outcomes in Failing Perimount Aortic Bioprostheses-A Multicenter Registry. / Ruge, Hendrik; Burri, Melchior; Schreyer, Julia et al.
I: Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions, Bind 106, Nr. 2, 08.2025, s. 1409-1420.

Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › peer review

Ruge, H, Burri, M, Schreyer, J, Georgescu, T-C, Frank, D, Kim, W-K, de Backer, O, Beyer, M, Schäfer, A, Fraccaro, C, Tarantini, G, Xhepa, E, Joner, M, Krane, M & Covarrubias, HAA 2025, 'Bioprosthetic Valve Fracturing in Valve-in-Valve TAVI: Clinical and Echocardiographic Outcomes in Failing Perimount Aortic Bioprostheses-A Multicenter Registry', Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions, bind 106, nr. 2, s. 1409-1420. https://doi.org/10.1002/ccd.31686

Ruge H, Burri M, Schreyer J, Georgescu TC, Frank D, Kim WK et al. Bioprosthetic Valve Fracturing in Valve-in-Valve TAVI: Clinical and Echocardiographic Outcomes in Failing Perimount Aortic Bioprostheses-A Multicenter Registry. Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions. 2025 aug.;106(2):1409-1420. Epub 2025 jun. 19. doi: 10.1002/ccd.31686

Ruge, Hendrik ; Burri, Melchior ; Schreyer, Julia et al. / Bioprosthetic Valve Fracturing in Valve-in-Valve TAVI : Clinical and Echocardiographic Outcomes in Failing Perimount Aortic Bioprostheses-A Multicenter Registry. I: Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions. 2025 ; Bind 106, Nr. 2. s. 1409-1420.

@article{f5a9ca8b6bd54f6588e48357b7d71145,

title = "Bioprosthetic Valve Fracturing in Valve-in-Valve TAVI: Clinical and Echocardiographic Outcomes in Failing Perimount Aortic Bioprostheses-A Multicenter Registry",

abstract = "BACKGROUND: Data comparing clinical and hemodynamic outcomes of bioprosthetic valve fracturing (BVF) and {"}standard{"}-postdilatation during valve-in-valve transcatheter heart valve implantation (ViV-TAVI) are lacking. The authors aimed to analyze hemodynamic and clinical outcomes of BVF compared to {"}standard{"}-postdilatation during ViV-TAVI.METHODS: The REDUCE registry included patients who underwent ViV-TAVI within a Perimount surgical aortic valve bioprosthesis (Edwards Lifesciences, USA). Procedures were categorized to no postdilatation, {"}standard{"}-postdilatation and BVF. Hemodynamic and clinical outcomes at 30 days were collected and compared. A linear regression model was built to predict mean aortic gradient after ViV-TAVI.RESULTS: A total of 240 patients from six European sites were included. Median age was 78 years [IQR 70; 83], logistic EuroSCORE calculated 20.0%[IQR 12.2; 33.1] and 159 patients (66%) were male. One hundred fourty-four Perimount valves (60%) had a true internal diameter (ID) ≤ 21 mm. Self-expanding valves (SEV) and ballon-expandable valves (BEV) were used in 60% and 40% of cases, respectively. One hundred sixteen procedures (48%) were executed without postdilatation, in 88 procedures (37%) {"}standard{"}-postdilatation and in 36 procedures (15%) BVF was used. 30-day survival was 93.3%. VARC-3 device success at 30 days was 71%. A multivariable regression analysis of the mean aortic gradient after ViV-TAVI showed a significant association with surgical valve size (-0.84 mmHg, p = 0.001; per 1 mm surgical valve size increase), execution of postdilatation (-3.25 mmHg, p = 0.007) and type of transcatheter heart valve (SEV: -7.31 mmHg, p < 0.001).CONCLUSIONS: When performing ViV-TAVI within a Perimount surgical aortic bioprosthesis with a true ID ≤ 21 mm, the hemodynamic valve performance is most optimal when implanting a SEV-TAV and when postdilating the TAV-in-SAV complex. BVF did not result in superior hemodynamics compared to {"}standard{"}-postdilatation.",

keywords = "Aged, Aged, 80 and over, Aortic Valve Stenosis/diagnostic imaging, Aortic Valve/diagnostic imaging, Bioprosthesis, Europe, Female, Heart Valve Prosthesis, Heart Valve Prosthesis Implantation/instrumentation, Hemodynamics, Humans, Male, Prosthesis Design, Prosthesis Failure, Recovery of Function, Registries, Risk Factors, Time Factors, Transcatheter Aortic Valve Replacement/adverse effects, Treatment Outcome, bioprostheic valve fracturing, valve-in-valve TAVI, hemodynamics",

author = "Hendrik Ruge and Melchior Burri and Julia Schreyer and Teodora-Cristiana Georgescu and Derk Frank and Won-Keun Kim and {de Backer}, Ole and Martin Beyer and Andreas Sch{\"a}fer and Chiara Fraccaro and Giuseppe Tarantini and Erion Xhepa and Michael Joner and Markus Krane and Covarrubias, {H{\'e}ctor Alfonso Alvarez}",

note = "{\textcopyright} 2025 The Author(s). Catheterization and Cardiovascular Interventions published by Wiley Periodicals LLC.",

year = "2025",

month = aug,

doi = "10.1002/ccd.31686",

language = "English",

volume = "106",

pages = "1409--1420",

journal = "Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions",

issn = "1522-1946",

publisher = "John Wiley and Sons Inc.",

number = "2",

}

TY - JOUR

T1 - Bioprosthetic Valve Fracturing in Valve-in-Valve TAVI

T2 - Clinical and Echocardiographic Outcomes in Failing Perimount Aortic Bioprostheses-A Multicenter Registry

AU - Ruge, Hendrik

AU - Burri, Melchior

AU - Schreyer, Julia

AU - Georgescu, Teodora-Cristiana

AU - Frank, Derk

AU - Kim, Won-Keun

AU - de Backer, Ole

AU - Beyer, Martin

AU - Schäfer, Andreas

AU - Fraccaro, Chiara

AU - Tarantini, Giuseppe

AU - Xhepa, Erion

AU - Joner, Michael

AU - Krane, Markus

AU - Covarrubias, Héctor Alfonso Alvarez

PY - 2025/8

Y1 - 2025/8

N2 - BACKGROUND: Data comparing clinical and hemodynamic outcomes of bioprosthetic valve fracturing (BVF) and "standard"-postdilatation during valve-in-valve transcatheter heart valve implantation (ViV-TAVI) are lacking. The authors aimed to analyze hemodynamic and clinical outcomes of BVF compared to "standard"-postdilatation during ViV-TAVI.METHODS: The REDUCE registry included patients who underwent ViV-TAVI within a Perimount surgical aortic valve bioprosthesis (Edwards Lifesciences, USA). Procedures were categorized to no postdilatation, "standard"-postdilatation and BVF. Hemodynamic and clinical outcomes at 30 days were collected and compared. A linear regression model was built to predict mean aortic gradient after ViV-TAVI.RESULTS: A total of 240 patients from six European sites were included. Median age was 78 years [IQR 70; 83], logistic EuroSCORE calculated 20.0%[IQR 12.2; 33.1] and 159 patients (66%) were male. One hundred fourty-four Perimount valves (60%) had a true internal diameter (ID) ≤ 21 mm. Self-expanding valves (SEV) and ballon-expandable valves (BEV) were used in 60% and 40% of cases, respectively. One hundred sixteen procedures (48%) were executed without postdilatation, in 88 procedures (37%) "standard"-postdilatation and in 36 procedures (15%) BVF was used. 30-day survival was 93.3%. VARC-3 device success at 30 days was 71%. A multivariable regression analysis of the mean aortic gradient after ViV-TAVI showed a significant association with surgical valve size (-0.84 mmHg, p = 0.001; per 1 mm surgical valve size increase), execution of postdilatation (-3.25 mmHg, p = 0.007) and type of transcatheter heart valve (SEV: -7.31 mmHg, p < 0.001).CONCLUSIONS: When performing ViV-TAVI within a Perimount surgical aortic bioprosthesis with a true ID ≤ 21 mm, the hemodynamic valve performance is most optimal when implanting a SEV-TAV and when postdilating the TAV-in-SAV complex. BVF did not result in superior hemodynamics compared to "standard"-postdilatation.

AB - BACKGROUND: Data comparing clinical and hemodynamic outcomes of bioprosthetic valve fracturing (BVF) and "standard"-postdilatation during valve-in-valve transcatheter heart valve implantation (ViV-TAVI) are lacking. The authors aimed to analyze hemodynamic and clinical outcomes of BVF compared to "standard"-postdilatation during ViV-TAVI.METHODS: The REDUCE registry included patients who underwent ViV-TAVI within a Perimount surgical aortic valve bioprosthesis (Edwards Lifesciences, USA). Procedures were categorized to no postdilatation, "standard"-postdilatation and BVF. Hemodynamic and clinical outcomes at 30 days were collected and compared. A linear regression model was built to predict mean aortic gradient after ViV-TAVI.RESULTS: A total of 240 patients from six European sites were included. Median age was 78 years [IQR 70; 83], logistic EuroSCORE calculated 20.0%[IQR 12.2; 33.1] and 159 patients (66%) were male. One hundred fourty-four Perimount valves (60%) had a true internal diameter (ID) ≤ 21 mm. Self-expanding valves (SEV) and ballon-expandable valves (BEV) were used in 60% and 40% of cases, respectively. One hundred sixteen procedures (48%) were executed without postdilatation, in 88 procedures (37%) "standard"-postdilatation and in 36 procedures (15%) BVF was used. 30-day survival was 93.3%. VARC-3 device success at 30 days was 71%. A multivariable regression analysis of the mean aortic gradient after ViV-TAVI showed a significant association with surgical valve size (-0.84 mmHg, p = 0.001; per 1 mm surgical valve size increase), execution of postdilatation (-3.25 mmHg, p = 0.007) and type of transcatheter heart valve (SEV: -7.31 mmHg, p < 0.001).CONCLUSIONS: When performing ViV-TAVI within a Perimount surgical aortic bioprosthesis with a true ID ≤ 21 mm, the hemodynamic valve performance is most optimal when implanting a SEV-TAV and when postdilating the TAV-in-SAV complex. BVF did not result in superior hemodynamics compared to "standard"-postdilatation.

KW - Aged

KW - Aged, 80 and over

KW - Aortic Valve Stenosis/diagnostic imaging

KW - Aortic Valve/diagnostic imaging

KW - Bioprosthesis

KW - Europe

KW - Female

KW - Heart Valve Prosthesis

KW - Heart Valve Prosthesis Implantation/instrumentation

KW - Hemodynamics

KW - Humans

KW - Male

KW - Prosthesis Design

KW - Prosthesis Failure

KW - Recovery of Function

KW - Registries

KW - Risk Factors

KW - Time Factors

KW - Transcatheter Aortic Valve Replacement/adverse effects

KW - Treatment Outcome

KW - bioprostheic valve fracturing

KW - valve-in-valve TAVI

KW - hemodynamics

UR - http://www.scopus.com/inward/record.url?scp=105008648706&partnerID=8YFLogxK

U2 - 10.1002/ccd.31686

DO - 10.1002/ccd.31686

M3 - Journal article

C2 - 40537943

SN - 1522-1946

VL - 106

SP - 1409

EP - 1420

JO - Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions

JF - Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions

IS - 2

ER -

Bioprosthetic Valve Fracturing in Valve-in-Valve TAVI: Clinical and Echocardiographic Outcomes in Failing Perimount Aortic Bioprostheses-A Multicenter Registry

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