Impact of Different Valve-in-Valve Positions on Functional Results of the New Generation of Balloon-Expandable Transcatheter Heart Valve.

Objectives: Very precise positioning of the transcatheter heart valve (THV) inside the degenerated SAV is a crucial factor for valve-in-valve (ViV) procedure to achieve optimal hemodynamic results. Therefore, our study aimed to investigate the impact of implantation depth on functional results after ViV procedures in a standardized in vitro setting.

Methods: THV (SAPIEN 3 Ultra 23-mm size) and three SAV models (Magna Ease, Trifecta, and Hancock II-all 21-mm size) were tested at different circulatory conditions in five different positions of the THV (2-6 mm) inside the SAV. Mean pressure gradient (MPG), effective orifice area (EOA), geometric orifice area (GOA), and pinwheeling index (PWI) were analyzed.

Results: EOA and MPG of the THV did not differ significantly regarding the position inside the Magna Ease and the Hancock II ( > 0.05). However, EOA differed significantly, depending on the position of the THV inside Trifecta (2 vs. 5 mm;  = 0.021 and 2 vs. 6 mm;  < 0.001). The THV presented the highest EOA (2.047 cm) and the lowest MPG (5.387 mm Hg) inside the Magna Ease, whereas the lowest EOA (1.335 cm) and the highest MPG (11.876 mm Hg) were shown inside the Hancock II. Additionally, the highest GOA and the lowest PWI of the THV were noticed inside the Magna Ease. The THV showed lower GOA and higher PWI inside the Trifecta when placed in a deeper position.

Conclusion: Deep implantation of the SAPIEN 3 Ultra inside the Trifecta correlates with impaired functional results. In contrast, the implantation position of the SAPIEN 3 Ultra inside the Magna Ease and the Hancock II did not have a significant effect on functional results.