{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T21:53:13Z","timestamp":1777931593075,"version":"3.51.4"},"reference-count":26,"publisher":"Texas Heart Institute Journal","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024]]},"abstract":"Abstract<\/jats:title>\n\nBackground:<\/jats:title>\nValve-in-valve (ViV) transcatheter aortic valve implantation (TAVI) is quickly becoming a routine and effective means by which to treat degenerated bioprosthetic valves. A known complication of ViV-TAVI is patient-prosthesis mismatch, which substantially affects survival. Bioprosthetic valve fracture is a method by which to reduce the risk of patient-prosthesis mismatch and post\u2013ViV-TAVI transvalvular gradients. This study sought to determine the safety and efficacy of post\u2013ViV-TAVI bioprosthetic valve fracture.<\/jats:p>\n<\/jats:sec>\n\nMethods:<\/jats:title>\nPatients with a history of surgical aortic valve replacement undergoing ViV-TAVI bioprosthetic valve fracture (N = 25) at the corresponding institution from 2015 to 2022 were cataloged for a retrospective analysis. The implanted transcatheter valves were Medtronic Evolut R, Evolut PRO, and Evolut PRO+. Gradients were assessed before and after implantation and after fracturing using transthoracic echocardiogram.<\/jats:p>\n<\/jats:sec>\n\nResults:<\/jats:title>\nThe mean left ventricular ejection fraction of patients who underwent fracturing was 55.04%. The average (SD) peak and mean (SD) transvalvular gradients before the intervention were 68.17 (19.09) mm Hg and 38.98 (14.37) mm Hg, respectively. After ViV-TAVI, the same gradients were reduced to 27.25 (12.27) mm Hg and 15.63 (6.47) mm Hg, respectively. After bioprosthetic valve fracture, the gradients further decreased to 17.59 (7.93) mm Hg and 8.860 (3.334) mm Hg, respectively. The average reduction in peak gradient associated with fracturing was 12.07 mm Hg (95% CI, 5.73-18.41 mm Hg; P<\/jats:italic> = .001). The average reduction in mean gradient associated with valve fracturing was 6.97 mm Hg (95% CI, 3.99-9.74 mm Hg; P<\/jats:italic> < .001).<\/jats:p>\n<\/jats:sec>\n\nConclusion:<\/jats:title>\nBioprosthetic valve fracture is a viable option for reducing residual transvalvular gradients after ViV-TAVI and should be considered in patients with elevated gradients (>20 mm Hg) or with concern for patient-prosthesis mismatch in patients who have an unacceptable risk for a redo sternotomy and surgical aortic valve replacement.<\/jats:p>\n<\/jats:sec>","DOI":"10.14503\/thij-23-8304","type":"journal-article","created":{"date-parts":[[2024,11,23]],"date-time":"2024-11-23T00:30:53Z","timestamp":1732321853000},"source":"Crossref","is-referenced-by-count":2,"title":["Effects of Bioprosthetic Valve Fracturing on Valve-in-Valve Transcatheter Aortic Valve Implantation Transvalvular Gradients"],"prefix":"10.14503","volume":"51","author":[{"given":"Osama","family":"Hallak","sequence":"first","affiliation":[{"name":"Department of Cardiovascular Medicine, Kettering Health, Kettering, Ohio"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Karley","family":"Fischer","sequence":"additional","affiliation":[{"name":"Boonshoft School of Medicine, Wright State University, Dayton, Ohio"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shaina","family":"Ailawadi","sequence":"additional","affiliation":[{"name":"Boonshoft School of Medicine, Wright State University, Dayton, Ohio"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Damian","family":"Valencia","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Kettering Health, Kettering, Ohio"},{"name":"Boonshoft School of Medicine, Wright State University, Dayton, Ohio"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yan","family":"Yatsynovich","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Kettering Health, Kettering, Ohio"},{"name":"Boonshoft School of Medicine, Wright State University, Dayton, Ohio"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Raja","family":"Nazir","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Kettering Health, Kettering, Ohio"},{"name":"Boonshoft School of Medicine, Wright State University, Dayton, Ohio"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brian","family":"Schwartz","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Kettering Health, Kettering, Ohio"},{"name":"Boonshoft School of Medicine, Wright State University, Dayton, Ohio"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"5628","reference":[{"issue":"1","key":"b1","series-title":"Ann Thorac Surg","first-page":"55","article-title":"Contemporary real-world outcomes of surgical aortic valve replacement in 141,905 low-risk, intermediate-risk, and high-risk patients","volume":"99","author":"Thourani VH","year":"2015","unstructured":"Thourani VH, Suri RM, Gunter RL, et al. Contemporary real-world outcomes of surgical aortic valve replacement in 141,905 low-risk, intermediate-risk, and high-risk patients. Ann Thorac Surg. 2015;99(1):55-61. doi:10.1016\/j.athoracsur.2014.06.050"},{"issue":"5","key":"b2","series-title":"J Thorac Cardiovasc Surg","first-page":"1262","article-title":"National trends in utilization and in-hospital outcomes of mechanical versus bioprosthetic aortic valve replacements","volume":"149","author":"Isaacs AJ","year":"2015","unstructured":"Isaacs AJ, Shuhaiber J, Salemi A, Isom OW, Sedrakyan A. National trends in utilization and in-hospital outcomes of mechanical versus bioprosthetic aortic valve replacements. J Thorac Cardiovasc Surg. 2015;149(5):1262-1269.e3. doi:10.1016\/j.jtcvs.2015.01.052"},{"issue":"16","key":"b3","series-title":"Circulation","first-page":"1647","article-title":"DEcIDE AVR (Developing Evidence to Inform Decisions about Effectiveness\u2013Aortic Valve Replacement) Research Team. 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