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.
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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.