OBJECTIVES This study reports an international experience using the transfemoral ACURATE neo transcatheter heart valve (Boston Scientific, Marlborough, Massachusetts) for the treatment of degenerated surgical aortic bioprostheses. BACKGROUND Transcatheter valve-in-valve procedures have emerged as an alternative to redo surgery. Supra-annular prostheses might be particularly useful in this indication. METHODS This is an international multicenter analysis including 85 patients from 14 centers in Europe and Canada undergoing an ACURATE neo valve-in-valve procedure from March 2015 to February 2019. RESULTS Internal diameter of the degenerated bioprosthesis was 20.3 ± 2.1 mm. Prosthesis size S was used in 70 (82%) procedures. The median depth of implantation was 3 mm and the upper crown of the ACURATE neo was positioned above the stent posts of the degenerated bioprosthesis in 54 (64%) and inside in 31 (36%). Mean transvalvular gradient before discharge was significantly lower if the upper crown was above the degenerated bioprosthesis (13.7 ± 5.9 mm Hg vs. 19.5 ± 10.0 mm Hg; p = 0.001). However, a high position of the ACURATE neo resulted in embolization in 1 patient, conversion to open-heart surgery in 1, and need for reintervention due to transcatheter heart valve failure within the first 18 months of follow-up in 4. CONCLUSIONS This early experience shows that a high implantation of the ACURATE neo with the upper crown above the stent posts of the degenerated bioprosthesis resulted in lower mean transvalvular gradients but a higher rate of malpositioning and early valve degeneration.

中文翻译：

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在退化的主动脉生物假体中使用ACURATE Neo进行瓣膜瓣植入术：国际多中心分析。

目的这项研究报告了国际经验，使用经股ACURATE新型经导管心脏瓣膜（波士顿科学公司，马萨诸塞州马尔伯勒市）治疗退化性外科主动脉生物假体。背景技术经导管瓣膜内瓣膜手术已经成为重做手术的替代方案。环上假体在这种适应症中可能特别有用。方法这是一项国际多中心分析，包括来自欧洲和加拿大14个中心的85例患者，于2015年3月至2019年2月进行了新的瓣膜新瓣膜手术。结果退化的生物假体的内径为20.3±2.1 mm。假体尺寸S用于70（82％）手术。植入的中位深度为3 mm，ACURATE neo的上冠位于退化的生物假体的支架柱上方，有54个（64％），内部有31个（36％）。如果上牙冠高于退化的生物假体，则出院前的平均瓣膜梯度明显降低（13.7±5.9 mm Hg vs. 19.5±10.0 mm Hg； p = 0.001）。然而，ACURATE neo的高位导致1例患者栓塞，1例转为心脏直视手术，并且在4例随访的头18个月内因经导管心脏瓣膜衰竭而需要再次介入治疗。