In this registry of patients who underwent transcatheter valve-in-valve implantation for degenerated bioprosthetic aortic valves, overall 1-year survival was 83.2%. Survival was lower among patients with small bioprostheses and those with predominant surgical valve stenosis.

were linearly related to PVR (Table)however the highest correlation with the severity of PVR was seen with the maximum diameter (r2ϭ0.48, pϽ0.001), mean diameter(r2ϭ0.47, pϽ0.0001), average diameter (r2ϭ0.48, pϽ0.0001) or the annular area (r2ϭ0.48, pϽ0.0001). Conclusions: This study demonstrates that 3DE measurements of the aortic annulus are feasible and are better predictors of PVR after TAVR than 2D sagittal diameter and should be incorporated into the algorithm for balloon-expandable transcatheter valve sizing.Background: Transcatheter aortic valve-in-valve (VIV) implantation is an emerging therapeutic alternative for patients with failed surgical bioprosthesis and may obviate the need for a redo surgery. We aimed to evaluate the clinical results of this technique using a large worldwide registry. Methods: The registry included 416 patients with degenerated aortic bioprosthetic valves (age 77.7 Ϯ 9.7 years; 55.3% men) from 54 cardiac centers. The mode of failure was stenosis (nϭ168, 40.4%), regurgitation (nϭ125, 30%), and combined stenosis and regurgitation (nϭ123, 29.6%). Implanted devices were Edwards SAPIEN (nϭ225), CoreValve (nϭ190) and Melody (nϭ1). Results: Adverse procedural outcomes included 11.1% device malposition and 1.9% ostial coronary obstruction. Post-procedure, valve maximum / mean gradients were 28.5 Ϯ 14.3 mmHg / 16.1 Ϯ 9.0, respectively. Independent predictors for high postprocedural gradients (mean Ն20 mmHg) were baseline bioprosthesis stenosis [vs. regurgitation, odds ratio (OR), 6.33, p Ͻ 0.001)] and the use of the Edwards SAPIEN device (OR 2.1, pϭ 0.008). At 30-day follow-up, all-cause mortality was 7.8% and 87.5% of patients were at New York Heart Association functional class I/II. One-year survival was 82.6%. The strongest independent predictor for 1-year mortality post VIV was baseline bioprosthesis stenosis (vs. regurgitation, OR 3.7, pϭ0.003). Conclusions:The VIV procedure is clinically effective in most patients, with 1-year results comparable with other TAVR cohorts. Baseline bioprosthetic stenosis is the strongest predictor for both elevated post-procedural gradients and 1-year mortality.

Compared with tricuspid AS, TAVR in bicuspid AS was associated with a similar prognosis, but lower device success rate. Procedural differences were observed in patients treated with the early-generation devices, whereas no differences were observed with the new-generation devices.

Bioprostheses are prone to structural valve degeneration, resulting in limited long-term durability. A significant challenge when comparing the durability of different types of bioprostheses is the lack of a standardized terminology for the definition of a degenerated valve. This issue becomes especially important when we try to compare the degeneration rate of surgically inserted and transcatheter bioprosthetic valves. This document, by the VIVID (Valve-in-Valve International Data), proposes practical and standardized definitions of valve degeneration and provides recommendations for the timing of clinical and imaging follow-up assessments accordingly. Its goal is to improve the quality of research and clinical care for patients with deteriorated bioprostheses by providing objective and strict criteria that can be utilized in future clinical trials. We hope that the adoption of these criteria by both the cardiological and surgical communities will lead to improved comparability and interpretation of durability analyses.

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