Valvular & structural heart diseaseCohort study
Clinical and Hemodynamic Outcomes of Balloon-Expandable Mitral Valve-in-Valve Positioning and Asymmetric Deployment
- Registry study
- core lab evaluation
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
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. JACC Cardiovasc Interv. Published 13 November 2023. doi:10.1016/j.jcin.2023.08.047
Summarised from the published abstract; every number is checked against it