Transcatheter aortic valve‑in‑valve implantation for failed surgical bioprostheses: results from the Polish Transcatheter Aortic Valve-in-Valve Implantation (ViV‑TAVI) Registry

Abstract

Introduction: Transcatheter aortic valve‑in ‑valve implantation (ViV‑TAVI) has emerged as an alternative to redo surgery in patients with failed surgical aortic bioprosthesis.

Objectives: We evaluated the safety and efficacy of ViV‑TAVI in Polish patients after surgical aortic valve replacement.

Patients and methods: This was a nationwide multicenter registry of ViV‑TAVI procedures. Data were collected using an online form, and the clinical follow ‑up lasted 1 year.

Results: From 2008 to 2020, 130 ViV‑TAVI procedures were performed (1.9% of all transcatheter aortic valve implantation [TAVI] cases). A considerable increase in ViV‑TAVI procedures since 2018 has been observed (n = 59, 45% of ViV‑TAVI cases). Hancock II, Freestyle, and homograft were the most frequently treated bioprostheses. The self ‑expanding supra ‑annular Corevalve / Evolut valve was used in 76% of cases. In 21% of cases, the mean postprocedural pressure gradient (PG) exceeded 20 mm Hg. All‑cause mortal‑ity at 1 year was 10.8%. Aortic valve stenosis was associated with a higher mean PG than aortic valve regurgitation or mixed disease (P = 0.004). Supra ‑annular transcatheter aortic valves were associated with lower mean PGs than intra ‑annular valves (P = 0.004). Second ‑generation devices were associated with shorter procedure time (120 min vs 135 min, P = 0.04), less frequent need for additional TAVI (2% vs 10%, P = 0.04), and lower 1‑year cardiovascular mortality (95% vs 82.8%, P = 0.03) than first‑generation valves.

Conclusions: Transcatheter treatment of failed bioprostheses is increasingly common, with the best hemodynamic effect shown for supra ‑annular valves. The introduction of second‑generation valves has improved procedural and clinical outcomes.