Valve-in-valve transcatheter aortic valve implantation for failing surgical aortic stentless bioprosthetic valves: A single-center experience

• Published in: The Journal of thoracic and cardiovascular surgery Vol. 150; no. 1; pp. 91 - 98
• Main Authors: Duncan, Alison, Davies, Simon, Di Mario, Carlo, Moat, Neil
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.07.2015
• Subjects: Adult; Aged; Aged, 80 and over; Bioprosthesis; Cardiothoracic Surgery; Degenerate stentless bioprosthesis; Female; Follow-Up Studies; Heart Valve Prosthesis; Humans; Male; Middle Aged; outcome; Prosthesis Design; Prosthesis Failure; Reoperation; Retrospective Studies; Stents; Transcatheter Aortic Valve Replacement - methods; transcatheter valve implantation; valve-in-valve; transcatheter valve implantation; ViV; MSCT; Degenerate stentless bioprosthesis; TAVI; 35.3.6; valve-in-valve; EuroSCORE; STS PROM; VARC-2; AVR; outcome; transcatheter aortic valve implantation; Society of Thoracic Surgeons 30-day predicted risk of mortality; aortic valve replacement; European System for Cardiac Operative Risk Evaluation; Valve Academic Research Consortium-2; multislice computed tomography
• ISSN: 0022-5223; 1097-685X; 1097-685X
• DOI: 10.1016/j.jtcvs.2015.03.021

Valve-in-valve (ViV) transcatheter aortic implantation (TAVI) is an alternative to redo surgery for patients with a failing aortic bioprosthesis. A lack of anatomic markers may complicate the procedure. This study reports procedural and midterm outcomes of patients undergoing ViV-TAVI for failing stentless bioprostheses, at a single institution. A total of 22 consecutive patients with failing homograft (n = 17), stented porcine valve (n = 3), aortic root bioprosthesis (n = 1), or native resuspended aortic valve (n = 1) (aged 74 ± 12 years; Society of Thoracic Surgeons 30-day predicted risk of mortality score: 14% ± 8%) were treated with ViV-TAVI, between 2007 and 2014. All had severe aortic regurgitation and were highly symptomatic before TAVI: 41% had chronic kidney disease; 32% had undergone previous coronary bypass grafts; 27% had previous percutaneous coronary intervention; 14% had severe pulmonary disease; 14% had had a stroke. All underwent TAVI with a self-expanding device. The 30-day mortality was 0%. No cases occurred of myocardial infarction, tamponade, stroke, severe bleeding, acute kidney injury, or major vascular complications. Three instances of device migration, and 1 of device embolization, occurred. Permanent pacing was required in 14%. Paravalvular aortic regurgitation was absent or mild in 19, and mild to moderate in 3. Average hospital stay was 8 ± 3 days; all patients were discharged home. Six-month and 1-year mortality was 4.8% and 14.3%, respectively. Aortic valve area and paravalvular aortic regurgitation were unchanged at 1 year. The ViV-TAVI procedure may be performed in high-risk patients with a degenerate stentless bioprosthesis with low 30-day mortality, and 1-year mortality of 14.3%. Although technically challenging, owing to a lack of anatomic markers, satisfactory positioning is possible in most cases, with excellent clinical and echocardiographic outcomes.