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.

Here, we report the existence of endothelial precursor (EPC) and stem cells in a distinct zone of the vascular wall that are capable to differentiate into mature endothelial cells, hematopoietic and local immune cells, such as macrophages. This zone has been identified to be localized between smooth muscle and adventitial layer of human adult vascular wall. It predominantly contains CD34-positive (+) but CD31-negative (-) cells, which also express VEGFR2 and TIE2. Only few cells in this zone of the vascular wall are positive for CD45. In a ring assay using the fragments of human internal thoracic artery (HITA), we show here that the CD34 + cells of the HITA-wall form capillary sprouts ex vivo and are apparently recruited for capillary formation by tumor cells. New vessels formed by these vascular wall resident EPCs express markers for angiogenically activated endothelial cells, such as CEACAM1, and also for mature endothelial cells, such as VE-cadherin or occludin. Vascular wall areas containing EPCs are found in large and middle sized arteries and veins of all organs studied here. These data suggest the existence of a 'vasculogenic zone' in the wall of adult human blood vessels, which may serve as a source for progenitor cells for postnatal vasculogenesis, contributing to tumor vascularization and local immune response.

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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.