Long-term outcomes after transcatheter aortic valve implantation in failed bioprosthetic valves. (27th June 2020)

• Record Type: Journal Article
• Authors: Bleiziffer, Sabine; Simonato, Matheus; Webb, John G; Rodés-Cabau, Josep; Pibarot, Philippe; Kornowski, Ran; Windecker, Stephan; Erlebach, Magdalena; Duncan, Alison; Seiffert, Moritz; Unbehaun, Axel; Frerker, Christian; Conzelmann, Lars; Wijeysundera, Harindra; Kim, Won-Keun; Montorfano, Matteo; Latib, Azeem; Tchetche, Didier; Allali, Abdelhakim; Abdel-Wahab, Mohamed; Orvin, Katia; Stortecky, Stefan; Nissen, Henrik; Holzamer, Andreas; Urena, Marina; Testa, Luca; Agrifoglio, Marco; Whisenant, Brian; Sathananthan, Janarthanan; Napodano, Massimo; Landi, Antonio; Fiorina, Claudia; Zittermann, Armin; Veulemans, Verena; Sinning, Jan-Malte; Saia, Francesco; Brecker, Stephen; Presbitero, Patrizia; De Backer, Ole; Søndergaard, Lars; Bruschi, Giuseppe; Franco, Luis Nombela; Petronio, Anna Sonia; Barbanti, Marco; Cerillo, Alfredo; Spargias, Konstantinos; Schofer, Joachim; Cohen, Mauricio; Muñoz-Garcia, Antonio; Finkelstein, Ariel; Adam, Matti; Serra, Vicenç; Teles, Rui Campante; Champagnac, Didier; Iadanza, Alessandro; Chodor, Piotr; Eggebrecht, Holger; Welsh, Robert; Caixeta, Adriano; Salizzoni, Stefano; Dager, Antonio; Auffret, Vincent; Cheema, Asim; Ubben, Timm; Ancona, Marco; Rudolph, Tanja; Gummert, Jan; Tseng, Elaine; Noble, Stephane; Bunc, Matjaz; Roberts, David; Kass, Malek; Gupta, Anuj; Leon, Martin B; Dvir, Danny;
• Is Part Of: European heart journal. Volume 41:Number 29(2020)
• Page Start: 2731
• Page End: 2742
• Publication Date: 2020-06-27
• Subjects: TAVR -- Aortic valve-in-valve -- Reintervention -- Severe prosthesis–patient mismatch -- SAPIEN valve; Cardiology -- Periodicals; Heart -- Diseases -- Periodicals; 616.12005
• DOI: 10.1093/eurheartj/ehaa544
• Languages: English
• ISSNs: 0195-668X

Abstract

Abstract: Aims: Due to bioprosthetic valve degeneration, aortic valve-in-valve (ViV) procedures are increasingly performed. There are no data on long-term outcomes after aortic ViV. Our aim was to perform a large-scale assessment of long-term survival and reintervention after aortic ViV. Methods and results: A total of 1006 aortic ViV procedures performed more than 5 years ago [mean age 77.7 ± 9.7 years; 58.8% male; median STS-PROM score 7.3% (4.2–12.0)] were included in the analysis. Patients were treated with Medtronic self-expandable valves (CoreValve/Evolut, Medtronic Inc., Minneapolis, MN, USA) ( n = 523, 52.0%), Edwards balloon-expandable valves (EBEV, SAPIEN/SAPIEN XT/SAPIEN 3, Edwards Lifesciences, Irvine, CA, USA) ( n = 435, 43.2%), and other devices ( n = 48, 4.8%). Survival was lower at 8 years in patients with small-failed bioprostheses [internal diameter (ID) ≤ 20 mm] compared with those with large-failed bioprostheses (ID > 20 mm) (33.2% vs. 40.5%, P = 0.01). Independent correlates for mortality included smaller-failed bioprosthetic valves [hazard ratio (HR) 1.07 (95% confidence interval (CI) 1.02–1.13)], age [HR 1.21 (95% CI 1.01–1.45)], and non-transfemoral access [HR 1.43 (95% CI 1.11–1.84)]. There were 40 reinterventions after ViV. Independent correlates for all-cause reintervention included pre-existing severe prosthesis–patient mismatch [subhazard ratio (SHR) 4.34 (95% CI 1.31–14.39)], device malposition [SHR 3.75 (95% CI 1.36–10.35)], EBEV [SHR 3.34 (95% CI 1.26–8.85)], and age [SHR 0.59 (95% CI 0.44–0.78)]. Conclusions: The size of the original failed valve may influence long-term mortality, and the type of the transcatheter valve may influence the need for reintervention after aortic ViV. Graphical Abstract: