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Resheathing of self-expanding bioprosthesis: Impact on procedural results, clinical outcome and prosthetic valve durability after transcatheter aortic valve implantation

Authors
  • Kefer, Joelle1
  • Maes, Frederic1
  • Renkin, Jean1
  • Kautbally, Shakeel1
  • De Meester, Christophe2
  • Delacour, Marine1
  • Pouleur, Anne-Catherine1
  • 1 Cliniques Universitaires Saint-Luc, Division of Cardiology and Intitut de Recherche Experimentale en Cardiologie (IREC), Brussels, Belgium
  • 2 Intitut de Recherche Experimentale en cardiologie (IREC), Brussels, Belgium
Type
Published Article
Journal
International Journal of Cardiology. Heart & Vasculature
Publisher
Elsevier
Publication Date
Jan 05, 2020
Volume
26
Identifiers
DOI: 10.1016/j.ijcha.2019.100462
PMID: 31921975
PMCID: PMC6948261
Source
PubMed Central
Keywords
Disciplines
  • Original Paper
License
Unknown

Abstract

Background New transcatheter aortic valves were recently developed, enabling to resheath and reposition the prosthesis. The aim of the present study was to investigate whether the resheath manoeuvre did not impair the outcome of patients and the bioprosthesis durability after transcatheter aortic valve implantation (TAVI). Methods and results On the 346 consecutive patients (84 ± 7 yrs-old, mean STS 6.7 ± 5%) undergoing a transfemoral TAVI in our institution since January 2008, 170 patients were implanted using a self-expanding valve (SEV). Among those, 39 (Group 1) required resheathing to achieve a successful implantation, while 131 did not require it (Group 2, N = 131). A balloon-expanding valve (BEV) was used in 176 patients (Group 3). Baseline characteristics were similar between groups. Device success was 98%, the rate of in-hospital death was 2%, and the number of procedural complications was similarly low, with no significant difference between groups. The follow-up was complete in 337 of 338 patients undergoing a successful TAVI (781 patients-year). Kaplan-Meier analysis showed that overall survival was 80 ± 2% and 42 ± 3% at 1 and 5 years respectively, with no difference between groups. On multivariate analysis, acute kidney injury, post-dilatation, pulmonary hypertension, porcelain aorta and STS score, but not resheath, were independant predictors of death after TAVI. The annual event rate of structural valve deterioration was 0.6% patients-year, and similar between groups. Conclusions Our study shows that SEV resheath did not impair the procedural results, the outcome of patients nor the valve durability at short term after TAVI.

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