Computed tomography (CT)-derived measures of annulus area can be used to flag cases of heightened risk for poor hemodynamics after valve-in-valve (VIV) procedures, according to recently published research.
The study, led by Danny Dvir, with the University of Washington in Seattle, was published online May 31 in Structural Heart, the new journal of the Cardiovascular Research Fund.
“Poor post-procedural hemodynamics are a significant limitation of aortic valve-in-VIV procedures. This adverse event is relatively common in these procedures and is considered the Achilles heel of this approach,” wrote Dvir and colleagues. “Being able to identify patients at risk for elevated post-VIV gradients in advance of the procedure would be very helpful to optimally plan the therapeutic approach during TAVR or refer the patient to conventional redo surgery, in which a surgical valve could be implanted,” the authors also stated.
The analysis included 84 patients who underwent pre-procedural CT. Patients had a median age of 79.9+9.6 years, and 65 percent were male. About half (49 percent) of the surgical valves were small (true ID <20 mm). The most frequent mechanism of failure (57.6 percent) was predominant stenosis, and a large majority (89.3 percent) of cases involved a stented surgical valve.
“The risk of poor post-procedural hemodynamics (high gradients and small effective orifice area) differed between the subgroups and was significantly worse in small surgical valves (true ID <20 mm) and best in intermediate/large surgical valves (true ID >20 mm) with CT-measured area mm2,” the authors wrote.
Greater knowledge of likely post procedural gradients after these increasingly common VIV procedures, the authors said, should enhance the decision making involved in treating the challenging patients who are the usual candidates for them.