Outcomes for TAVR Valve-in-Valve Implantation
What are the intermediate-term outcomes in patients treated with transcatheter valve-in-valve (VinV) implantation?
This study examined outcomes in 73 patients treated with transcatheter VinV implantation for aortic (n = 42) or mitral (n = 31) bioprosthetic valve dysfunction using an Edwards balloon-expandable transcatheter valve. All patients were considered at prohibitive risk for conventional valve replacement.
Median follow-up was 2.5 years. The procedure was successful in 99% (72/73) of cases. Adverse events at 30 days of follow-up included all-cause mortality in 1%, disabling stroke in 1%, life-threatening bleeding in 4%, kidney injury requiring hemodialysis in 3%, and intervention for coronary obstruction in 1%. All patients had ≤ mild paravalvular regurgitation. Survival at 1, 2, 3, 4, and 5 years was 89%, 80%, 70%, 62%, and 41%, respectively. Median survival was 4.5 years for aortic and 4.4 years for mitral VinV implantation. On multivariable analysis in patients treated with aortic VinV, a surgical valve size <23 mm was associated with increased mortality (hazard ratio, 6.2; 95% confidence interval, 1.01-22.8; p = 0.01).
Transcatheter VinV implantation for dysfunctional aortic or mitral bioprosthetic valves has high procedural success and has acceptable outcomes in a cohort at prohibitive risk of redo surgical valve replacement.
Prior studies have demonstrated that transcatheter VinV implantation is feasible in patients with dysfunctional aortic and mitral bioprosthetic valve replacements, and is associated with reasonable short- and intermediate-term outcomes. This study examines a larger cohort with intermediate-term follow-up, and procedural success and outcomes appear acceptable in this cohort. These results suggest that this may be a reasonable option for patients at prohibitive risk of redo surgical valve replacement. While we have limited data on longer-term follow-up, estimated 5-year survival in this extreme-risk cohort was only 41%. This suggests that we need better strategies to identify which patients are more or less likely to benefit from this.
Clinical Topics: Cardiac Surgery, Invasive Cardiovascular Angiography and Intervention, Valvular Heart Disease, Aortic Surgery, Cardiac Surgery and VHD, Interventions and Structural Heart Disease, Mitral Regurgitation
Keywords: Aortic Valve Insufficiency, Bioprosthesis, Cardiac Surgical Procedures, Heart Valve Diseases, Heart Valve Prosthesis, Heart Valve Prosthesis Implantation, Mitral Valve Insufficiency, Prostheses and Implants, Renal Dialysis, Stroke, Transcatheter Aortic Valve Replacement
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