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Multicenter Study
. 2022 Dec;37(12):4382-4388.
doi: 10.1111/jocs.17084. Epub 2022 Nov 30.

Multicenter experience with valve-in-valve transcatheter aortic valve replacement compared with primary, native valve transcatheter aortic valve replacement

Michael P Robich  1 , Alexander Iribarne  2 , David Butzel  1 , Anthony W DiScipio  2 , Harold L Dauerman  3 , Bruce J Leavitt  4 , Joseph P DeSimone  2 , Megan Coylewright  5 , James M Flynn  6 , Benjamin M Westbrook  6 , Peter N Ver Lee  7 , Mina Zaky  8 , Reed Quinn  1 , David J Malenka  5
Affiliations
Multicenter Study

Multicenter experience with valve-in-valve transcatheter aortic valve replacement compared with primary, native valve transcatheter aortic valve replacement

Michael P Robich et al. J Card Surg. 2022 Dec.

Abstract

Background: Valve-in-valve (ViV) transcatheter aortic valve replacement (TAVR) offers an alternative to reoperative surgical aortic valve replacement. The short- and intermediate-term outcomes after ViV TAVR in the real world are not entirely clear.

Patients and methods: A multicenter, retrospective analysis of a consecutive series of 121 ViV TAVR patients and 2200 patients undergoing primary native valve TAVR from 2012 to 2017 at six medical centers. The main outcome measures were in-hospital mortality, 30-day mortality, stroke, myocardial infarction, acute kidney injury, and pacemaker implantation.

Results: ViV patients were more likely male, younger, prior coronary artery bypass graft, "hostile chest," and urgent. 30% of the patients had Society of Thoracic Surgeons risk score <4%, 36.3% were 4%-8% and 33.8% were >8%. In both groups many patients had concomitant coronary artery disease. Median time to prosthetic failure was 9.6 years (interquartile range: 5.5-13.5 years). 82% of failed surgical valves were size 21, 23, or 25 mm. Access was 91% femoral. After ViV, 87% had none or trivial aortic regurgitation. Mean gradients were <20 mmHg in 54.6%, 20-29 mmHg in 30.6%, 30-39 mmHg in 8.3% and ≥40 mmHg in 5.87%. Median length of stay was 4 days. In-hospital mortality was 0%. 30-day mortality was 0% in ViV and 3.7% in native TAVR. There was no difference in in-hospital mortality, postprocedure myocardial infarction, stroke, or acute kidney injury.

Conclusion: Compared to native TAVR, ViV TAVR has similar peri-procedural morbidity with relatively high postprocedure mean gradients. A multidisciplinary approach will help ensure patients receive the ideal therapy in the setting of structural bioprosthetic valve degeneration.

Keywords: aortic valve replacement; cardiac catheterization/intervention; heart valve replacement; percutaneous; transapical; transcatheter.

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References

REFERENCES

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