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Valve in Valve in Rapid Deployment Valves
13 February 2020 (online)
Objectives: Rapid deployment valves such as the Edwards Intuity and the Percival L were implanted many times since their development. Due to the expected degeneration of these valves over the years, the need for valve replacement through reoperation or valve in valve (ViV) TAVI is on the rise. Yet, to our knowledge, data on the suitability of different ViV combinations with rapid deployment valves are sparse. We therefore initiated an in vitro test series to identify problematic as well as advantageous match-ups leading to recommendations for in vivo application.
Methods: Two different rapid deployment valves—Edwards Intuity 23 mm (EI) and Percival L (PL)—were examined in vitro in combination with either 23 mm Edwards Sapien3 TAVI (ES3) or 23 mm Medtronic Corevalve (MC) as ViV. Tests were performed in a HKP 2.0 pulse duplicator simulating 70 bpm and 70 mL stroke volume (cardiac output 4.9 L/min). Closing time and volume, leakage, regurgitation fraction, cardiac output, and systolic pressure gradient were detected and compared. Valve opening cycles were visualized using a Casio EX-FH20 high-speed camera. Inner diameters of the ViV combinations were measured with Hegar sticks.
Results: The relatively bulky stent structure of the MC presented a significant hurdle against ViV positioning within Percival L even in vitro and could not be examined in the pulse duplicator. ViV resulted in a reduction of the inner diameter by 2 mm. Mean systolic pressure gradients decreased significantly in EI after ViV (EI: 10.5 ± 0.88 mm Hg, EI + MC: 8.99 ± 0.51 mm Hg, EI + ES3: 7.64 ± 0.49 mm Hg), while they increased in Percival L (PL: 8.06 ± 0.42 mm Hg, PL + ES3: 10.58 ± 0.65 mm Hg).
Conclusion: Combining MC with Percival L cannot be recommended. Also Edwards Intuity matched better with ES3 than with MC. Further research is necessary to identify optimal combinations for the expected rising number of patients with rapid deployment valves scheduled for ViV within the coming years.