The International TrifectaTM and EpicTM Valve-in-Valve Registry: insights into clinical & hemodynamic outcomes
The International TrifectaTM and EpicTM Valve-in-Valve Registry: insights into clinical & hemodynamic outcomes
Background: little is known about the clinical and hemodynamic outcome of valve-in-valve transcatheter aortic valve replacement (ViV-TAVR) for failed Trifecta surgical aortic bioprotheses.
Aims: we aimed to compare outcomes of valve-in-valve transcatheter aortic valve replacement (ViV-TAVR into failed TrifectaTM vs. ViV-TAVR into a standard aortic bioprosthetic valve with internally mounted leaflets (EpicTM, Abbott, Minneapolis, MN).
Methods: data of consecutive patients who underwent ViV-TAVR into either failed TrifectaTM or EpicTM bioprostheses between October 2015 and June 2020 were retrospectively collected within the International Trifecta and Epic Valve-in-Valve Registry, and analyzed for a primary composite outcome of 30-day mortality and/or coronary obstruction (CO), defined as: (1) CO resulting in myocardial infarction and/or cardiogenic shock, or (2) CO requiring emergent coronary intervention.
Results: a total of 76 patients (49 Trifecta, 27 Epic) with a median age of 80 years (interquartile range [IQR] 75.0; 82.0]) and a median Society of Thoracic Surgeons-score of 5.4 (IQR 4.0; 9.8) were identified. Coronary protection techniques were more frequently performed in Trifecta than Epic patients (29.6% vs. 0%, p = 0.01). The primary composite outcome was observed in three Trifecta versus five Epic cases (6.1% vs. 20%, p = 0.1), which included one case of CO following ViV-TAVR into Epic requiring stenting. Increased rates of patient-prosthesis mismatch (PPM) following valve-in-Epic were found (41.7% vs. 75%, p = 0.08). Survival at a median of 365 days was 86.2% and did not differ between groups (log-rank p = 0.37).
Conclusions: compared to a stented prosthesis without increased risk of CO, ViV-TAVR into Trifecta prostheses can be performed with low risk of CO and acceptable short-term clinical outcomes. As the rate of post-ViV PPM is substantial for both prostheses, careful patient selection is warranted. (NCT05389631).
Epic-valve, Trifecta-valve, coronary obstruction, externally mounted leaflets, valve-in-valve transcatheter aortic valve replacement, Trifecta -valve, Epic -valve
1711-1718
Raschpichler, Matthias
fc2fe7b2-a79a-45fc-a5bc-5334681c0524
Abdel-Wahab, Mohamed
41839ad2-b532-4e4d-8cce-5aaed5f1ec85
Curzen, Nick
70f3ea49-51b1-418f-8e56-8210aef1abf4
Wilbring, Manuel
0bff39f1-34b8-43d3-a2d3-ee51eb00efba
Dubois, Christoph
bf7a5c19-106f-4927-bb18-44c09dab72c7
Lam, Kayan
337a9a16-76b3-4854-862a-ee40acfd7b7b
Faerber, Gloria
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Nagel, Jana
3829a830-cc7b-4a02-998b-1660e2e27705
Thiele, Holger
456d42b3-6e63-4ebf-8781-75cc1ba44918
Borger, Michael A.
723dc13d-117a-4e92-be81-6b02ff35b6ab
1 June 2025
Raschpichler, Matthias
fc2fe7b2-a79a-45fc-a5bc-5334681c0524
Abdel-Wahab, Mohamed
41839ad2-b532-4e4d-8cce-5aaed5f1ec85
Curzen, Nick
70f3ea49-51b1-418f-8e56-8210aef1abf4
Wilbring, Manuel
0bff39f1-34b8-43d3-a2d3-ee51eb00efba
Dubois, Christoph
bf7a5c19-106f-4927-bb18-44c09dab72c7
Lam, Kayan
337a9a16-76b3-4854-862a-ee40acfd7b7b
Faerber, Gloria
7b15ee55-4df9-4333-846e-e0531b001567
Nagel, Jana
3829a830-cc7b-4a02-998b-1660e2e27705
Thiele, Holger
456d42b3-6e63-4ebf-8781-75cc1ba44918
Borger, Michael A.
723dc13d-117a-4e92-be81-6b02ff35b6ab
Raschpichler, Matthias, Abdel-Wahab, Mohamed, Curzen, Nick, Wilbring, Manuel, Dubois, Christoph, Lam, Kayan, Faerber, Gloria, Nagel, Jana, Thiele, Holger and Borger, Michael A.
(2025)
The International TrifectaTM and EpicTM Valve-in-Valve Registry: insights into clinical & hemodynamic outcomes.
Catheterization and Cardiovascular Interventions, 105 (7), .
(doi:10.1002/ccd.31492).
Abstract
Background: little is known about the clinical and hemodynamic outcome of valve-in-valve transcatheter aortic valve replacement (ViV-TAVR) for failed Trifecta surgical aortic bioprotheses.
Aims: we aimed to compare outcomes of valve-in-valve transcatheter aortic valve replacement (ViV-TAVR into failed TrifectaTM vs. ViV-TAVR into a standard aortic bioprosthetic valve with internally mounted leaflets (EpicTM, Abbott, Minneapolis, MN).
Methods: data of consecutive patients who underwent ViV-TAVR into either failed TrifectaTM or EpicTM bioprostheses between October 2015 and June 2020 were retrospectively collected within the International Trifecta and Epic Valve-in-Valve Registry, and analyzed for a primary composite outcome of 30-day mortality and/or coronary obstruction (CO), defined as: (1) CO resulting in myocardial infarction and/or cardiogenic shock, or (2) CO requiring emergent coronary intervention.
Results: a total of 76 patients (49 Trifecta, 27 Epic) with a median age of 80 years (interquartile range [IQR] 75.0; 82.0]) and a median Society of Thoracic Surgeons-score of 5.4 (IQR 4.0; 9.8) were identified. Coronary protection techniques were more frequently performed in Trifecta than Epic patients (29.6% vs. 0%, p = 0.01). The primary composite outcome was observed in three Trifecta versus five Epic cases (6.1% vs. 20%, p = 0.1), which included one case of CO following ViV-TAVR into Epic requiring stenting. Increased rates of patient-prosthesis mismatch (PPM) following valve-in-Epic were found (41.7% vs. 75%, p = 0.08). Survival at a median of 365 days was 86.2% and did not differ between groups (log-rank p = 0.37).
Conclusions: compared to a stented prosthesis without increased risk of CO, ViV-TAVR into Trifecta prostheses can be performed with low risk of CO and acceptable short-term clinical outcomes. As the rate of post-ViV PPM is substantial for both prostheses, careful patient selection is warranted. (NCT05389631).
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TrifectaViV_manuscript_R2_clean
- Accepted Manuscript
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Cathet Cardio Intervent - 2025 - Raschpichler - The International TrifectaTM and EpicTM Valve‐in‐Valve Registry Insights
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More information
Accepted/In Press date: 1 March 2025
e-pub ahead of print date: 27 March 2025
Published date: 1 June 2025
Keywords:
Epic-valve, Trifecta-valve, coronary obstruction, externally mounted leaflets, valve-in-valve transcatheter aortic valve replacement, Trifecta -valve, Epic -valve
Identifiers
Local EPrints ID: 500647
URI: http://eprints.soton.ac.uk/id/eprint/500647
ISSN: 1522-1946
PURE UUID: dcba879f-4369-4c43-a678-2f5c53cdd133
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Date deposited: 07 May 2025 16:57
Last modified: 28 Aug 2025 01:44
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Contributors
Author:
Matthias Raschpichler
Author:
Mohamed Abdel-Wahab
Author:
Manuel Wilbring
Author:
Christoph Dubois
Author:
Kayan Lam
Author:
Gloria Faerber
Author:
Jana Nagel
Author:
Holger Thiele
Author:
Michael A. Borger
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