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Review
. 2025 Nov;114(11):1445-1454.
doi: 10.1007/s00392-025-02640-5. Epub 2025 Apr 29.

Long-term outcome of bail-out ViV-TAVI at index procedure

Isabel Horn  1 , Hazem Omran  2 , Sabine Bleiziffer  3 , Smita Scholtz  2 , Kai Friedrichs  2 , Cornelia Piper  2 , Johanna Bormann  2 , Sara Waezsada  2 , Max Potratz  2 , René Schramm  3 , Volker Rudolph  2 , Tanja K Rudolph  2
Affiliations
Review

Long-term outcome of bail-out ViV-TAVI at index procedure

Isabel Horn et al. Clin Res Cardiol. 2025 Nov.

Abstract

Objective: This study aimed to compare in-hospital and long-term outcomes of patients with bail-out valve-in-valve TAVI due to a primarily failed transcatheter aortic valves procedure (bViV-TAVI) versus a successful transcatheter aortic valve implantation (TAVI).

Methods: We recorded bViV-TAVI procedures at our center from February 2011 to March 2022. Primary endpoint was long-term mortality. In-hospital mortality, stroke, acute kidney failure, need for new permanent pacemaker, and duration of intervention were secondary endpoints.

Results: 4555 patients undergoing TAVI were retrospectively included. 231 matched (77:154) patients were analyzed. BViV-TAVI was a rare event (1.9%). In 76.7% of the cases transcatheter valve embolization and migration were the reasons for implanting a second valve in the same procedure. Significant PVL accounted for bViV-TAVI in 23.4% of the patients. The duration of the intervention was significantly longer for the bViV-TAVI group (p < 0.001). BViV-TAVI patients showed higher rates of a new permanent pacemaker implantation (p = 0.013) and the postprocedural mean pressure was significantly higher (p = 0.03). Concerning the other secondary endpoints there was a trend for a higher event rate in bVIV-TAVI patients which did not reach significant difference. After an average follow-up period of 4.9 ± 3.0 years, mortality was significantly higher in the bViV-TAVI group (54.5% vs. 39.0%, p = 0.025).

Conclusion: The implantation of a second valve during the same procedure as bail-out is a feasible alternative treatment option in patients with failed transcatheter aortic valve procedures. However, increased long-term mortality must be taken into account.

Keywords: Aortic stenosis; Bailout; Conversion; Embolization; Migration; TAVI; Valve-in-valve.

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Conflict of interest statement

Declarations. Conflict of interest: S. Bleiziffer declares speaker fess from Edwards Lifesciences and Boston Scientific and speaker fees and advisory board activites for Medtronic and Abbott. T.K. Rudolph is proctor for JenaValve. All other authors declare to have no conflicts of interest.

References

    1. Vahanian A, Beyersdorf F, Praz F, Milojevic M, Baldus S, Bauersachs J et al (2022) 2021 ESC/EACTS guidelines for the management of valvular heart disease. Eur Heart J 43:561–632. 10.1093/eurheartj/ehab395 - PubMed
    1. Kuck K-H, Bleiziffer S, Eggebrecht H, Ensminger S, Frerker C, Möllmann H et al (2020) Konsensuspapier der Deutschen Gesellschaft für Kardiologie (DGK) und der Deutschen Gesellschaft für Thorax-, Herz- und Gefäßchirurgie (DGTHG) zur kathetergestützten Aortenklappenimplantation (TAVI) 2020. Kardiologe 14:182–204. 10.1007/s12181-020-00398-w
    1. Leon MB, Smith CR, Mack MJ, Makkar RR, Svensson LG, Kodali SK et al (2016) Transcatheter or surgical aortic-valve replacement in intermediate-risk patients. N Engl J Med 374:1609–1620. 10.1056/NEJMoa1514616 - PubMed
    1. Makkar RR, Thourani VH, Mack MJ, Kodali SK, Kapadia S, Webb JG et al (2020) Five-year outcomes of transcatheter or surgical aortic-valve replacement. N Engl J Med 382:799–809. 10.1056/NEJMoa1910555 - PubMed
    1. Mack MJ, Leon MB, Thourani VH, Makkar R, Kodali SK, Russo M et al (2019) Transcatheter aortic-valve replacement with a balloon-expandable valve in low-risk patients. N Engl J Med 380:1695–1705. 10.1056/NEJMoa1814052 - PubMed

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