Long-Term Outcomes After Transcatheter Aortic Valve-in-Valve Replacement

Abstract

Background: Data on long-term outcomes after valve-in-valve (ViV) transcatheter aortic valve replacement (TAVR) are scarce. The objective of this study was to determine the long-term clinical outcomes and structural valve degeneration (SVD) over time in patients undergoing ViV-TAVR. Methods and Results: Consecutive patients undergoing ViV-TAVR in 9 centers between 2009 and 2015 were included. Patients were followed yearly, and clinical and echocardiography data were collected prospectively. SVD was defined as subclinical (increase >10 mm Hg in mean transvalvular gradient+decrease >0.3 cm 2 in valve area or new-onset mild or moderate aortic regurgitation) and clinically relevant (increase >20 mm Hg in mean transvalvular gradient+decrease >0.6 cm 2 in valve area or new-onset moderate-to-severe aortic regurgitation). A total of 116 patients (mean age, 76±11 years; 64.7% male; mean Society of Thoracic Surgeons score, 8.0±5.1%) were included. Balloon- and self-expandable valves were used in 47.9% and 52.1% of patients, respectively, and 30-day mortality was 6.9%. At a median follow-up of 3 years (range, 2–7 years), 30 patients (25.9%) had died, 20 of them (17.2%) from cardiovascular causes. Average mean transvalvular gradients remained stable up to 5-year follow-up ( P =0.92), but clinically relevant SVD occurred in 3/99 patients (3.0%), and 15/99 patients (15.1%) had subclinical SVD. One patient with SVD had redo ViV-TAVR. Conclusions: About one-fourth of ViV-TAVR recipients had died after a median follow-up of 3 years. Overall valve hemodynamics remained stable over time and clinically relevant SVD was infrequent, but 1 out of 10 patients exhibited some degree of SVD.

Aortic Stenosis and Transcatheter Aortic Valve Implantation: Current Status and Future Directions in Korea

“…However, a recent long-term follow-up study reported that hemodynamic stability of valve-in-valve TAVI was sustained for five years. The incidence of clinically relevant structural valve degeneration was 3.0%, which is similar to the results obtained in TAVI for native valves 65). Although redo SAVR has been considered the gold standard for management of a failing bioprosthetic aortic valve, valve-in-valve TAVI may gradually replace the surgery if durability and hemodynamic improvement is guaranteed.…”

Valve-in-Valve TAVR: State-of-the-Art Review

“…10 In a recent long-term series by de Freitas Campos Guimarães et al with a median follow-up of 3 years after ViV TAVR, 25.9% of patients had died (17.2% from cardiovascular causes). 17 New SVD was present in 18% of patients, but severe (>20 mmHg increase in gradient) in only 3%; in the entire cohort there was no significant increase in the valve gradient over time. Older age, low ejection fraction (EF), renal failure, BE and small surgical valve size were associated with late mortality risk in univariate analysis.…”

The Current Perspectives in Valve-in-Valve Transcatheter Aortic Valve Replacement

“…de Freitas Campos Guimarães et ak [27] 2018 116 Thirty-day mortality; 6.9%. Three-year survival rate; 74.1%.…”