As valve-in-valve (ViV) transcatheter aortic valve implantation is still an evolving
method, we evaluated the development of early and midterm outcomes after ViV and conventional
redo-surgical aortic valve replacement (SAVR) over the past 2 decades. In-hospital
databases were retrospectively screened for patients ≥60 years treated for failing
bioprosthetic aortic valves at our center. Clinical and follow-up characteristics
were compared between patients who underwent ViV or redo-SAVR according to valve academic
research consortium-2 (VARC-2) definitions. The comparison of outcome parameters was
adjusted for baseline differences between groups. Between June 2002 and April 2020,
209 patients with ViV and 65 redo-SAVR patients met inclusion criteria. No significant
differences were found in 30 days (ViV 3.8%, SAVR 3.1%, p = 0.778) or 6-month mortality
(ViV 14.0%, SAVR 7.5%, p = 0.283). As patients with ViV less frequently experienced
acute kidney injury (stage II or III) and life-threatening bleeding, they more frequently
reached the 30-day VARC-2 combined safety end point (79.2% vs 61.5%, odds ratio [OR]
2.540, p = 0.023). Patients with ViV less frequently reached clinical efficacy (68.3%
vs 84.6%, OR 0.408, p = 0.041) and device success (79.9% vs 92.3%, OR 0.311, p = 0.040)
end points, because of higher frequency of postprocedural transvalvular gradients
>20 mm Hg. However, over the past decade, VARC-2 clinical efficacy and device success
rates continuously increased in ViV cases. In conclusion, ViV and SAVR were associated
with similar acute mortality and different beneficial and adverse outcome profiles
in this single-center cohort. Results after ViV procedures have continuously improved
over the past years.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to American Journal of CardiologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Reoperative surgical aortic valve replacement versus transcatheter valve-in-valve replacement for degenerated bioprosthetic aortic valves.Ann Thorac Surg. 2016; 102: 1452-1458
- Transcatheter valve-in-valve implantation versus redo surgical aortic valve replacement in patients with failed aortic bioprostheses.Interact Cardiovasc Thorac Surg. 2017; 24: 63-70
- Transcatheter aortic valve replacement for degenerative bioprosthetic surgical valves: results from the global valve-in-valve registry.Circulation. 2012; 126: 2335-2344
- Transcatheter aortic valve replacement of failed surgically implanted bioprostheses: the STS/ACC registry.J Am Coll Cardiol. 2018; 72: 370-382
- Meta-analysis of valve-in-valve transcatheter versus redo surgical aortic valve replacement.Thorac Cardiovasc Surg. 2019; 67: 243-250
- Transcatheter valve-in-valve aortic valve replacement as an alternative to surgical re-replacement.J Am Coll Cardiol. 2020; 76: 489-499
- Comparison of in-hospital outcomes and readmissions for valve-in-valve transcatheter aortic valve replacement vs. reoperative surgical aortic valve replacement: a contemporary assessment of real-world outcomes.Eur Heart J. 2020; 41: 2747-2755
- Incidence, predictors, and clinical outcomes of coronary obstruction following transcatheter aortic valve replacement for degenerative bioprosthetic surgical valves: insights from the VIVID registry.Eur Heart J. 2018; 39: 687-695
- Aortic valve replacement in bioprosthetic failure: insights from the Society of Thoracic Surgeons National Database.Ann Thorac Surg. 2020; 110: 1637-1642
- Contemporary outcomes of repeat aortic valve replacement: a benchmark for transcatheter valve-in-valve procedures.Ann Thorac Surg. 2015; 100: 1298-1304
- Updated standardized endpoint definitions for transcatheter aortic valve implantation: the Valve Academic Research Consortium-2 consensus document.J Thorac Cardiovasc Surg. 2013; 145: 6-23
- Transcatheter aortic valve implantation within degenerated aortic surgical bioprostheses: PARTNER 2 Valve-in-Valve registry.J Am Coll Cardiol. 2017; 69: 2253-2262
- Transcatheter aortic valve implantation in failed bioprosthetic surgical valves.JAMA. 2014; 312: 162-170
- Short-term outcome and hemodynamic performance of next-generation self-expanding versus balloon-expandable transcatheter aortic valves in patients with small aortic annulus: a multicenter propensity-matched comparison.Circ Cardiovasc Interv. 2017; 10e005013
- Bioprosthetic valve fracture: technical insights from a multicenter study.J Thorac Cardiovasc Surg. 2019; 158 (e1): 1317-1328
- Outcomes of valve-in-valve transcatheter aortic valve implantation with and without bioprosthetic valve fracture.EuroIntervention. 2021; 17: 848-855
- Bioprosthetic valve fracture: predictors of outcome and follow-up. Results from a multicenter study.Catheter Cardiovasc Interv. 2021; 98: 756-764
- Valve-in-valve implantation of a novel and small self-expandable transcatheter heart valve in degenerated small surgical bioprostheses: the Hamburg experience.Catheter Cardiovasc Interv. 2014; 84: 486-493
- Valve-in-valve transcatheter aortic valve implantation for degenerated bioprosthetic heart valves.JACC Cardiovasc Interv. 2011; 4: 1218-1227
- Valve Academic Research Consortium 3: Updated endpoint definitions for aortic valve clinical research.J Am Coll Cardiol. 2021; 77: 2717-2746
Article Info
Publication History
Published online: March 17, 2022
Received in revised form:
January 23,
2022
Received:
November 7,
2021
Footnotes
This work is supported by the Clinician Scientist Programme of the German Center for Cardiovascular Research (DZHK) FKZ 81 × 3710109, Berlin, Germany.
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
