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A reappraisal of bioprosthetic aortic valve failure related to structural valve degeneration

Session Poster Session 4

Speaker Thierry Le Tourneau

Event : ESC Congress 2019

  • Topic : valvular, myocardial, pericardial, pulmonary, congenital heart disease
  • Sub-topic : Intervention
  • Session type : Poster Session

Authors : T Le Tourneau (Nantes,FR), C Cueff (Nantes,FR), L Guerma (Nantes,FR), G Guimbretiere (Nantes,FR), N Piriou (Nantes,FR), K Warin-Fresse (Nantes,FR), R Capoulade (Nantes,FR), JM Serfaty (Nantes,FR), J Veziers (Nantes,FR), T Senage (Nantes,FR), JC Roussel (Nantes,FR)

Authors:
T. Le Tourneau1 , C. Cueff1 , L. Guerma1 , G. Guimbretiere1 , N. Piriou1 , K. Warin-Fresse1 , R. Capoulade1 , J.M. Serfaty1 , J. Veziers2 , T. Senage1 , J.C. Roussel1 , 1Institut du Thorax, Inserm UMR 1087 - Nantes - France , 2SFR Bonamy, RMES, Inserm UMR S1229, SC3M - Nantes - France ,

Topic(s):
Valvular Heart Disease: Intervention

Citation:
European Heart Journal ( 2019 ) 40 ( Supplement ), 2297

Background: Structural valve degeneration (SVD) remains a major complication of aortic bioprostheses.

Purpose: We aimed to assess the mode of SVD leading to bioprosthetic aortic valve failure (BVF) in a large series of patients.

Methods: Between 2010 and 2017, we prospectively enrolled 261 consecutive patients with BVF related to SVD. All patients underwent a clinical work-up. Explanted bioprostheses were analysed for assessing the mechanism of SVD.

Results: The delay from surgery to SVD diagnosis was 8.5±3.3 (1.7 to 21.4) years, 10 years after exclusion of a specific type of bioprosthesis. Of the 261 SVD patients, 150 (57%) had mainly a stenotic type, and 111 (43%) a regurgitant type. In regurgitant SVD bioprosthesis was more frequently porcine (19 vs 7%, P=0.002), prosthesis diameter was larger (23.2±2.5 vs 21.6±1.9 mm; P<0.0001), severe mismatch was less frequent (6 vs 17%, P=0.005), cardiovascular risk factors and especially diabetes, obesity and hypertension were less frequent, patients were more often in NYHA class 3–4 (64 vs 49%; p=0.015), Nt-pro BNP was significantly higher (P<0.0001), and diuretic treatment was more frequent (73 vs 61%, P=0.04). Bioprostheses were explanted during redo surgery in 112 (43%) patients. Of these 112 bioprostheses, moderate to severe calcifications were present in 94 (83.9%) and was the main cause of either stenotic (n=64, 57.1%) or regurgitant SVD. A cusp tear (n=46) accounted for 41.1% of the explanted SVD. A perforation, a recent thrombus or a delamination process were occasionally identified. Structural degeneration developed with minimal calcification in 18 (16.1%) bioprostheses.

Conclusion: Structural valve degeneration remains a matter of concern in current practice with a mean delay of 8 to 10 years after surgery. Beside classical SVD with extensive calcification process other types of SVD can be observed with minimal calcification.

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