Transcatheter replacement of failed bioprosthetic valves: Large multicenter assessment of the effect of implantation depth on hemodynamics after aortic valve-in-valve

Matheus Simonato, John Webb, Ran Kornowski, Alec Vahanian, Christian Frerker, Henrik Nissen, Sabine Bleiziffer, Alison Duncan, Josep Rodés-Cabau, Guilherme F. Attizzani, Eric Horlick, Azeem Latib, Raffi Bekeredjian, Marco Barbanti, Thierry Lefevre, Alfredo Cerillo, José María Hernández, Giuseppe Bruschi, Konstantinos Spargias, Alessandro IadanzaStephen Brecker, José Honório Palma, Ariel Finkelstein, Mohamed Abdel-Wahab, Pedro Lemos, Anna Sonia Petronio, Didier Champagnac, Jan Malte Sinning, Stefano Salizzoni, Massimo Napodano, Claudia Fiorina, Antonio Marzocchi, Martin Leon, Danny Dvir

Research output: Contribution to journalArticlepeer-review

97 Scopus citations


Background - Transcatheter valve implantation inside failed bioprosthetic surgical valves (valve-in-valve [ViV]) may offer an advantage over reoperation. Supra-annular transcatheter valve position may be advantageous in achieving better hemodynamics after ViV. Our objective was to define targets for implantation that would improve hemodynamics after ViV. Methods and Results - Cases from the Valve-in-Valve International Data (VIVID) registry were analyzed using centralized core laboratory assessment blinded to clinical events. Multivariate analysis was performed to identify independent predictors of elevated postprocedural gradients (mean ≥20 mm Hg). Optimal implantation depths were defined by receiver operating characteristic curve. A total of 292 consecutive patients (age, 78.9±8.7 years; 60.3% male; 157 CoreValve Evolut and 135 Sapien XT) were evaluated. High implantation was associated with significantly lower rates of elevated gradients in comparison with low implantation (CoreValve Evolut, 15% versus 34.2%; P=0.03 and Sapien XT, 18.5% versus 43.5%; P=0.03, respectively). Optimal implantation depths were defined: CoreValve Evolut, 0 to 5 mm; Sapien XT, 0 to 2 mm (0-10% frame height); sensitivities, 91.3% and 88.5%, respectively. The strongest independent correlate for elevated gradients after ViV was device position (high: odds ratio, 0.22; confidence interval, 0.1-0.52; P=0.001), in addition to type of device used (CoreValve Evolut: odds ratio, 0.5; confidence interval, 0.28-0.88; P=0.02) and surgical valve mechanism of failure (stenosis/mixed baseline failure: odds ratio, 3.12; confidence interval, 1.51-6.45; P=0.002). Conclusions - High implantation inside failed bioprosthetic valves is a strong independent correlate of lower postprocedural gradients in both self- and balloon-expandable transcatheter valves. These clinical evaluations support specific implantation targets to optimize hemodynamics after ViV.

Original languageEnglish (US)
Article numbere003651
JournalCirculation: Cardiovascular Interventions
Issue number6
StatePublished - Jun 1 2016
Externally publishedYes


  • aortic valve
  • bioprosthesis
  • hemodynamics
  • multivariate analysis
  • transcatheter aortic valve replacement

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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