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Amat-Santos IJ, García-Gómez M, de Marco F, Won-Keun K, Brito J, Halim J, Jose J, Sengotuvelu G, Seth A, Terkelsen C, Protasiewicz M, Bonilla N, García B, Sánchez-Luna JP, Blasco-Turrión S, González JC, González-Bartol E, Ijsselmuiden AJJ, Gómez-Salvador I, Carrasco Moraleja M, San Román A. Latest-iteration balloon- and self-expandable transcatheter valves for severe bicuspid aortic stenosis: the TRITON study. Rev Esp Cardiol (Engl Ed) 2023; 76:872-880. [PMID: 36898524 DOI: 10.1016/j.rec.2023.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 02/09/2023] [Indexed: 03/11/2023]
Abstract
INTRODUCTION AND OBJECTIVES No comparisons have been published yet regarding the newest iteration of balloon- and self-expandable transcatheter heart valves for the treatment of bicuspid aortic valve (BAV) stenosis. METHODS Multicenter registry of consecutive patients with severe BAV stenosis treated with balloon-expandable transcatheter heart valves (Myval and SAPIEN 3 Ultra, S3U) or self-expanding Evolut PRO+(EP+). TriMatch analysis was carried out to minimize the impact of baseline differences. The primary endpoint of the study was 30-day device success, and the secondary endpoints were the composite and individual components of early safety at 30 days. RESULTS A total of 360 patients (age 76.6±7.6 years, 71.9% males) were included: 122 Myval (33.9%), 129 S3U (35.8%), and 109 EP+(30.3%). The mean STS score was 3.6±1.9%. There were no cases of coronary artery occlusion, annulus rupture, aortic dissection, or procedural death. The primary endpoint of device success at 30 days was significantly higher in the Myval group (Myval: 100%; S3U: 87.5%; and EP+: 81.3%), mainly due to higher residual aortic gradients with S3U and greater≥moderate aortic regurgitation (AR) with EP+. No significant differences were found in the unadjusted rate of pacemaker implantation. CONCLUSIONS In patients with BAV stenosis deemed unsuitable for surgery, Myval, S3U and EP+showed similar safety but balloon-expandable Myval had better gradients than S3U, and both balloon-expandable devices had lower residual AR than EP+, suggesting that, taking into consideration the patient-specific risks, any of these devices can be selected with optimal outcomes.
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Affiliation(s)
- Ignacio J Amat-Santos
- Departamento de Cardiología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Spain.
| | - Mario García-Gómez
- Departamento de Cardiología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Spain
| | | | - Kim Won-Keun
- Cardiology Department, Kerckhoff-Klinik, Bad Nauheim, Germany
| | - Joao Brito
- Cardiology Department, Hospital Santa Cruz, Lisbon, Portugal
| | - Jonathan Halim
- Cardiology Department, Amphia Hospital, Breda, The Netherlands
| | - John Jose
- Cardiology Department, Christian Medical College Vellore, Tamil Nadu, India
| | | | - Ashok Seth
- Cardiology Department, Fortis Escorts Heart Institute, New Delhi Hospital, Delhi, India
| | | | - Marcin Protasiewicz
- Cardiology Department, Institute of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland
| | - Nelson Bonilla
- Departamento de Cardiología, Hospital Médico Quirúrgico, Instituto Salvadoreño del Seguro Social, San Salvador, El Salvador
| | - Bruno García
- Departamento de Cardiología, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - Juan Pablo Sánchez-Luna
- Departamento de Cardiología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Sara Blasco-Turrión
- Departamento de Cardiología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - José Carlos González
- Departamento de Cardiología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Esther González-Bartol
- Departamento de Cardiología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | | | - Itziar Gómez-Salvador
- Departamento de Cardiología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Spain
| | - Manuel Carrasco Moraleja
- Departamento de Cardiología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Spain
| | - Alberto San Román
- Departamento de Cardiología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Spain
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Blasco-Turrión S, Serrador-Frutos A, Jose J, Sengotuvelu G, Seth A, Aldana VG, Sánchez-Luna JP, Gonzalez-Gutiérrez JC, García-Gómez M, Gómez-Herrero J, Aristizabal C, San Román JA, Amat-Santos IJ. Transcatheter Mitral Valve-in-Valve Implantation with the Balloon-Expandable Myval Device. J Clin Med 2022; 11:jcm11175210. [PMID: 36079140 PMCID: PMC9457220 DOI: 10.3390/jcm11175210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 08/15/2022] [Accepted: 08/29/2022] [Indexed: 11/16/2022] Open
Abstract
Background: The vast majority of transcatheter valve-in-valve (ViV) mitral procedures have been reported with the SAPIEN family. We aimed to report the preliminary experience with the Myval balloon-expandable device in this setting. Methods: Multicenter retrospective study of high-risk surgical patients with mitral bioprosthesis degeneration undergoing transcatheter ViV implantation with Myval device. Results: A total of 11 patients from five institutions were gathered between 2019 and 2022 (age 68 ± 7.8, 63% women). The peak and mean transvalvular gradients were 27 ± 5 mmHg and 14.7 ± 2.3 mmHg, respectively, and the predicted neo-left ventricular outflow tract (neo-LVOT) area was 183.4 ± 56 mm2 (range: 171 to 221 mm2). The procedures were performed via transfemoral access in all cases (through echocardiography-guided transeptal puncture (81.8% transesophageal, 11.2% intracardiac)). Technical success was achieved in all cases, with no significant residual mitral stenosis in any of them (peak 7.2 ± 2.7 and mean gradient 3.4 ± 1.7 mmHg) and no complications during the procedure. There were no data of LVOT obstruction, migration, or paravalvular leak in any case. Mean hospital stay was 3 days, with one major vascular complication and no stroke. At 6-month follow-up, there was one case with suboptimal anticoagulation presenting an increase in the transmitral gradients (mean 15 mmHg) that normalized after optimization of the anticoagulation, but no other relevant events. Conclusions: Transseptal ViV mitral implantation with the balloon-expandable Myval device was feasible and safe avoiding redo surgery in high-risk patients with bioprosthesis degeneration.
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Affiliation(s)
- Sara Blasco-Turrión
- Cardiology Department, Hospital Clínico Universitario de Valladolid, 47003 Valladolid, Spain
| | - Ana Serrador-Frutos
- Cardiology Department, Hospital Clínico Universitario de Valladolid, 47003 Valladolid, Spain
- Centro de Investigación en Red—Enfermedades Cardiovasculares, 28029 Madrid, Spain
| | - John Jose
- Cardiology Unit 2, Christian Medical College Hospital Vellore, Vellore 632004, India
| | | | - Ashok Seth
- Cardiology Department, Fortis Escorts Heart Institute, New Delhi 110025, India
| | - Victor G. Aldana
- Cardiology Department, Clinica Medicadiz, Ibagué 730006, Colombia
| | - Juan Pablo Sánchez-Luna
- Cardiology Department, Hospital Clínico Universitario de Valladolid, 47003 Valladolid, Spain
| | | | - Mario García-Gómez
- Cardiology Department, Hospital Clínico Universitario de Valladolid, 47003 Valladolid, Spain
| | - Javier Gómez-Herrero
- Cardiology Department, Hospital Clínico Universitario de Valladolid, 47003 Valladolid, Spain
| | - Cristhian Aristizabal
- Cardiology Department, Hospital Clínico Universitario de Valladolid, 47003 Valladolid, Spain
| | - J. Alberto San Román
- Cardiology Department, Hospital Clínico Universitario de Valladolid, 47003 Valladolid, Spain
| | - Ignacio J. Amat-Santos
- Cardiology Department, Hospital Clínico Universitario de Valladolid, 47003 Valladolid, Spain
- Correspondence: ; Tel.: +34-983-42-00-26; Fax: +34-983-25-53-05
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