Valvular & structural heart disease

Clinical and Hemodynamic Outcomes of Balloon-Expandable Mitral Valve-in-Valve Positioning and Asymmetric Deployment: The VIVID Registry

JACC Cardiovasc IntervPublished Registry study

Authors' conclusion

Valve stenosis is common after mitral ViV. Asymmetry was associated with residual stenosis. Depth of implantation on its own was not associated with residual stenosis but was associated with LVOT obstruction.

Study context

Population
Patients undergoing SAPIEN 3 mitral valve-in-valve (ViV) in the VIVID Registry
Participants
222 patients
Exposure
Device position and asymmetry in mitral ViV
Outcome
Residual mitral valve stenosis (mean gradient ≥5 mm Hg) and LVOT obstruction by implantation depth and asymmetry
Methodological detailscore lab evaluation
  • Core lab evaluation

Main finding

As reported in the abstract

Residual stenosis
50%
Mean gradient
5.0 ± 2.6 mm Hg
Left ventricular outflow tract (LVOT) obstruction
7 cases (3.2%)
Implantation depth as predictor of residual stenosis, OR
1.19 (0.92-1.55); P = 0.184 (95% CI)
LVOT obstruction, more atrial vs less atrial implantation
0.7% vs 7.1%; P = 0.009
LVOT obstruction per 10% atrial implantation, OR
0.48 (0.24-0.98); P = 0.044 (95% CI)
Asymmetry per 10% increase as independent predictor of residual stenosis, OR
2.30 (1.10-4.82); P = 0.027 (95% CI)

Observational data: associations, not effects.

Further findings

Device position

Mean asymmetry
6.2% ± 4.4%
Mean depth of implantation (atrial)
19.0% ± 10.3%

Original publication

Clinical and Hemodynamic Outcomes of Balloon-Expandable Mitral Valve-in-Valve Positioning and Asymmetric Deployment: The VIVID Registry. JACC Cardiovasc Interv. Published 13 November 2023. doi:10.1016/j.jcin.2023.08.047

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