Work

Acute Frame Recoil Following Transcatheter Mitral Valve-in-Valve Replacement: Incidence and Impact on Hemodynamics

Year: 2025

Type: article

Abstract: Background: Transcatheter mitral valve-in-valve replacement (ViV-TMVR) using balloon-expandable transcatheter heart valves (THVs) has emerged as a promising treatment for patients with degenerative bioprosthetic mitral valves. While the phenomenon of acute elastic recoil of the valve frame is well-recognized in transcatheter aortic valve implantation, its impact in the context of ViV-TMVR remains unexplored. Our study objective was to evaluate the incidence, magnitude, and hemodynamic impact of acute frame recoil. Methods: This retrospective study analyzed 70 patients (61% female, median age 76) who underwent ViV-TMVR (July 2016-July 2022). Recoil was measured using angiographic images at full balloon expansion and immediately after deflation. Measurements were taken at 3 THV levels (left atrium, mid-level, and ventricular). Recoil was calculated as the absolute and relative difference in frame diameter before and after balloon deflation. Results: Mean frame diameter decreased after balloon deflation. Mean absolute and relative recoil were 0.68 ± 0.33 mm and 2.62% ± 1.37%, respectively, peaking at the THV waist (3.46% ± 2.34%). Recoil increased with balloon-sizing ratio and decreased after postdilation. Recoil at prosthesis waist is positively associated with 30-day and 1-year TMMG, even after adjusting for the true internal diameter of the surgical heart valve, THV size, anticoagulant prescription at discharge, predischarge TMMG, and heart rate. Conclusions: Higher frame recoil following ViV-TMVR is associated with higher TMMG at 30-day and 1-year follow-ups. Optimizing balloon sizing may reduce recoil, improve valve performance, and enhance long-term outcomes.

Source: Structural Heart

DOI: 10.1016/j.shj.2025.100465