Impact of implant depth on hydrodynamic function with the ALLEGRA transcatheter heart valve following valve-in-valve intervention.

AIMS: We assessed the impact of implant depth on hydrodynamic function following valve-in-valve (VIV) intervention using the ALLEGRA (New Valve Technology, Hechingen, Germany) transcatheter heart valve (THV) in three different surgical valve designs.

METHODS AND RESULTS: Multiple implantation depths (+2mm, -2mm and -6mm) were tested using a 23mm ALLEGRA THV for VIV intervention in 19mm, 21mm, 23mm, and 25mm Epic, Mitroflow and Magna Ease bioprosthetic valves. Multimodality imaging and hydrodynamic evaluation was performed at each implantation depth. The 23mm ALLEGRA valve had gradients <20mmHg in the Mitroflow and Epic valves sized ³21mm, and in all sizes of the Magna Ease valve. Gradients did not increase significantly at lower implantation depths. The 19mm Epic (+2mm: 20.1±0.6mmHg, -2mm: 18.8±0.5mmHg, -6mm: 22.8±0.3mmHg) and 19mm Mitroflow (+2mm: 24.1±0.2mmHg, -2mm: 31.5±0.3mmHg, -6mm: 25.6±0.2mmHg) valves, had elevated mean gradients. In larger sized surgical valves (³23mm) the regurgitant fraction was higher at low implantation depths. Pinwheeling was significantly worse in the smaller sized (£21mm) surgical valves and also at low (<-2mm) implantation depth.

CONCLUSIONS: The 23mm ALLEGRA valve had favourable (<20mmHg) gradients in all surgical valves sized ³21mm, even when the THV was implanted low. In 19mm sized Mitroflow and Epic valves, gradients were elevated (>20mmHg). While there was no major difference in mean transvalvular gradients, leaflet pinwheeling was worse at lower implantation depths.