{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,2]],"date-time":"2025-08-02T19:39:16Z","timestamp":1754163556273,"version":"3.41.2"},"reference-count":22,"publisher":"Oxford University Press (OUP)","issue":"8","license":[{"start":{"date-parts":[[2025,5,17]],"date-time":"2025-05-17T00:00:00Z","timestamp":1747440000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,7,31]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Aims<\/jats:title>\n                  <jats:p>The mitral valve-in-valve (MVIV) procedure has emerged as an important therapy in failing surgical bioprosthetic valves. We aimed to evaluate factors associated with outcome following MVIV intervention, specifically the impact of 30-day MVIV gradient. We also explored the value of intraprocedural MVIV three-dimensional anatomic orifice area (3D-AOA) by transoesophageal echocardiography in a subset of patients (n = 68).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods and results<\/jats:title>\n                  <jats:p>Consecutive MVIV patients from a single institution with 30-day transthoracic echocardiography (TTE) were included (N = 100). Clinical and echocardiographic variables were evaluated. The primary outcome was one-year composite of all-cause mortality, heart failure hospitalization or re-intervention. Multivariable analysis was performed to determine predictors of primary outcome. Mean age was 77.3 \u00b1 10.6 years and pre-intervention mean mitral gradient was 11.5 \u00b1 4.0 mmHg. Thirty-day MVIV mean gradient was 7.4 \u00b1 2.6 mmHg with \u22641+ residual regurgitation in 99.0% of patients. Multivariable analysis identified MVIV mean gradient as the only independent determinant of the primary outcome (HR 1.31, CI: 1.07\u20131.61, P = 0.009). MVIV 3D-AOA was associated with a 30-day MVIV mean gradient of &amp;gt;7 mmHg by TTE (ROC-AUC 0.8, P &amp;lt; 0.001), and patients with 3D-AOA &amp;gt; 2 cm2 had significantly lower 1-year all-cause mortality (2.5% vs. 18.7%, Kaplan\u2013Meier log-rank P = 0.03).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Elevated 30-day mean gradient is associated with worse outcomes after MVIV, and smaller intraprocedural MVIV 3D-AOA is associated with a higher 30-day mean gradient and worse mortality. Optimizing MVIV orifice area at the time of procedure may improve valve haemodynamics and patient outcomes.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ehjci\/jeaf152","type":"journal-article","created":{"date-parts":[[2025,5,17]],"date-time":"2025-05-17T07:01:19Z","timestamp":1747465279000},"page":"1442-1451","source":"Crossref","is-referenced-by-count":0,"title":["Clinical impact of residual gradient and 3D orifice area after transcatheter mitral valve-in-valve implantation"],"prefix":"10.1093","volume":"26","author":[{"given":"Cvetan","family":"Trpkov","sequence":"first","affiliation":[{"name":"UBC Centre for Cardiovascular Innovation\u2014Centre d\u2019Innovation Cardiovasculaire, Life Sciences Centre, 2350 Health Sciences Mall, University of British Columbia , Vancouver, BC, Canada V6T 1Z3"},{"name":"Centre for Heart Valve Innovation, St Paul\u2019s and Vancouver General Hospitals, University of British Columbia , 1081 Burrard Street, Vancouver, British Columbia, Canada V6Z 1Y6"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6686-865X","authenticated-orcid":false,"given":"Aaisha","family":"Ferkh","sequence":"additional","affiliation":[{"name":"UBC Centre for Cardiovascular Innovation\u2014Centre d\u2019Innovation Cardiovasculaire, Life Sciences Centre, 2350 Health Sciences Mall, University of British Columbia , Vancouver, BC, Canada V6T 1Z3"},{"name":"Centre for Heart Valve Innovation, St Paul\u2019s and Vancouver General Hospitals, University of British Columbia , 1081 Burrard Street, Vancouver, British Columbia, Canada V6Z 1Y6"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mariama","family":"Akodad","sequence":"additional","affiliation":[{"name":"UBC Centre for Cardiovascular Innovation\u2014Centre d\u2019Innovation Cardiovasculaire, Life Sciences Centre, 2350 Health Sciences Mall, University of British Columbia , Vancouver, BC, Canada V6T 1Z3"},{"name":"Centre for Heart Valve Innovation, St Paul\u2019s and Vancouver General Hospitals, University of British Columbia , 1081 Burrard Street, Vancouver, British Columbia, Canada V6Z 1Y6"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brian","family":"Chiang","sequence":"additional","affiliation":[{"name":"UBC Centre for Cardiovascular Innovation\u2014Centre d\u2019Innovation Cardiovasculaire, Life Sciences Centre, 2350 Health Sciences Mall, University of British Columbia , Vancouver, BC, Canada V6T 1Z3"},{"name":"Centre for Heart Valve Innovation, St Paul\u2019s and Vancouver General Hospitals, University of British Columbia , 1081 Burrard Street, Vancouver, British Columbia, Canada V6Z 1Y6"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrew","family":"Chatfield","sequence":"additional","affiliation":[{"name":"UBC Centre for Cardiovascular Innovation\u2014Centre d\u2019Innovation Cardiovasculaire, Life Sciences Centre, 2350 Health Sciences Mall, University of British Columbia 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