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Background&amp;Objective <p>Valve-in-valve-in-valve (ViViV) implantation will be considered after the second valve deterioration as an increasing number of patients aged &lt; 60 years undergo transcatheter aortic valve replacement (TAVR). We aimed to investigate the hemodynamic outcomes after ViViV procedures.</p> Method <p>Evolut and Venus A with size of 23&#xa0;mm and 26&#xa0;mm were selected for the testing. Cardiovascular hydrodynamic tests were conducted using the in Vitro Pulse Duplicator system.</p> Result <p>ViViV configuration of 26&#xa0;mm-in-26&#xa0;mm-in-26&#xa0;mm demonstrates a larger effective orifice area (EOA) than the 23&#xa0;mm-in-26&#xa0;mm-in-26&#xa0;mm configuration. The transvalvular mean pressure gradient (MPG) of three 26&#xa0;mm combination were 8.3 ± 1.9 mmHg for Venus-A and 13.2 ± 1.6 mmHg for Evolut, which were acceptable.</p> Conclusion <p>The ViViV valve combination employing three 26&#xa0;mm Venus-A or Evolut self-expanding valves, as opposed to the 23&#xa0;mm-in-26&#xa0;mm-in-26&#xa0;mm configuration, exhibited favorable hemodynamic performance as demonstrated by in the vitro testing.</p>

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Hemodynamic performance of valve-in-valve-in-valve implantation for transcatheter heart valve: an in vitro simulation study

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年5月12日

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  • Yuliang Long,
  • Wentao Yan,
  • Dawei Lin,
  • Jian Guo,
  • Daxin Zhou,
  • Wenzhi Pan,
  • Junbo Ge

摘要

Background&Objective

Valve-in-valve-in-valve (ViViV) implantation will be considered after the second valve deterioration as an increasing number of patients aged < 60 years undergo transcatheter aortic valve replacement (TAVR). We aimed to investigate the hemodynamic outcomes after ViViV procedures.

Method

Evolut and Venus A with size of 23 mm and 26 mm were selected for the testing. Cardiovascular hydrodynamic tests were conducted using the in Vitro Pulse Duplicator system.

Result

ViViV configuration of 26 mm-in-26 mm-in-26 mm demonstrates a larger effective orifice area (EOA) than the 23 mm-in-26 mm-in-26 mm configuration. The transvalvular mean pressure gradient (MPG) of three 26 mm combination were 8.3 ± 1.9 mmHg for Venus-A and 13.2 ± 1.6 mmHg for Evolut, which were acceptable.

Conclusion

The ViViV valve combination employing three 26 mm Venus-A or Evolut self-expanding valves, as opposed to the 23 mm-in-26 mm-in-26 mm configuration, exhibited favorable hemodynamic performance as demonstrated by in the vitro testing.