A comparison of valve‐in‐valve transcatheter aortic valve replacement in failed stentless versus stented surgical bioprosthetic aortic valves

Abstract

Objectives The objectives of this study were to compare short‐ and intermediate‐term clinical outcomes, procedural complications, TAVR prosthesis hemodynamics, and paravalvular leak (PVL) in stentless and stented groups. Background Valve‐in‐valve (ViV) transcatheter aortic valve replacement (TAVR) is an alternative to surgical redo for bioprosthetic valve failure. There have been limited data on ViV in stentless surgical valves. Methods We retrospectively analyzed 40 patients who underwent ViV TAVR in prior surgical bioprosthetic valves at Wake Forest Baptist Medical Center from October 2014 to September 2017. Eighty percent (32/40) ViV TAVRs were in stentless, while 20% (8/40) were in stented bioprosthetic valves. Results The primary mode of bioprosthetic valve failure for ViV implantation in the stentless group was aortic insufficiency (78%, 25/32), while in the stented group was aortic stenosis (75%, 6/8). The ViV procedure success was 96.9% (31/32) in stentless group and 100% in stented group (8/8). There were no significant differences in all‐cause mortality at 30 days between stentless and stented groups (6.9%, 2/31 versus 0%, 0/8, P = 0.33) and at 1 year (0%, 0/25 versus 0%, 0/5). In the stentless group, 34.4% (11/32) required a second valve compared to the stented group of 0% (0/8). There was a significant difference in the mean aortic gradient at 30‐day follow‐up (12.33 ± 6.33 mmHg and 22.63 ± 8.45 mmHg in stentless and stented groups, P < 0.05) and at 6‐month follow‐up (9.75 ± 5.07 mmHg and 24.00 ± 11.28 mmHg, P < 0.05), respectively. Conclusions ViV in the stentless bioprosthetic aortic valve has excellent procedural success and intermediate‐term results. Our study shows promising data that may support the application of TAVR in stentless surgical aortic valve. However, further and larger studies need to further validate our single center's experience.

Transcatheter valve-in-valve implantation for degenerated stentless aortic bioroots

“…Choi et al compared surgical ViV in patients with stentless aortic valves (n=32) versus ViV-TAVR in patients with degenerated stented aortic valves (n=8). The procedural success rate in the stentless group was 96.9%, with 6.9% allcause mortality at 30 days, versus 100% procedural success and no mortality in the stented group (32). However, data regarding ViV-TAVR to repair failed stentless bio-ARRs or VSARRs are limited.…”

Outcomes after transcatheter valve-in-valve implantation using a balloon-expandable Edwards Sapien valve in patients with degenerated Freestyle aortic bioprosthesis

“…(II) Early complications after ViV treatment must be considered particularly during post-procedural hospital stay. So far, most data of ViV TAVI were derived from a heterogeneous mix of degenerated stented and stentless bioprostheses subsumed within cohorts or registries of patients with ViV TAVI, respectively, although it is well known that the underling morphological and functional alterations completely differ between stented and stentless bioprostheses (3,15). Furthermore, in previous ViV studies, results of self-expandable transcatheter valves from different manufacturers were mixed with results from different generations of balloon-expandable Edwards valves (2,3,16).…”

TAVI-in-homograft (TiH): open transcatheter aortic valve replacement in calcified aortic homograft case reports

“…In such cases a TAVI-in-Homograft (TiH) procedure may be the only reasonable possibility to overcome the anatomical finding discovered at the operating theatre, as also other groups [9, 10] have described.…”