Transcatheter Aortic Valve Replacement for Degenerative Bioprosthetic Surgical Valves: Results From the Global Valve-in-Valve Registry
What are the clinical results of transcatheter aortic valve-in-valve (VIV) implantation using a large, worldwide registry?
The Global Valve-in-Valve Registry included 202 patients with degenerated bioprosthetic valves (age 77.7 ± 10.4 years; 52.5% men) from 38 cardiac centers. Bioprosthesis mode of failure was stenosis (n = 85, 42%), regurgitation (n = 68, 34%), or combined stenosis and regurgitation (n = 49, 24%). Implanted devices included CoreValve (n = 124) and Edwards SAPIEN (n = 78).
Procedural success was achieved in 93.1% of cases. Adverse procedural outcomes included initial device malposition in 15.3% of cases, and ostial coronary obstruction in 3.5%. Post-procedure, valve maximum/mean gradients were 28.4 ± 14.1 mm Hg/15.9 ± 8.6 mm Hg, and 95% of patients had ≤ +1 degree of aortic regurgitation. At 30-day follow-up, all-cause mortality was 8.4%, and 83.7% of patients were at New York Heart Association functional class I/II. One-year follow-up was obtained in 87 patients, with 85.8% survival of treated patients.
The authors concluded that the VIV procedure is clinically effective in the vast majority of patients with degenerated stenotic or regurgitant bioprosthetic valves.
This pilot evaluation of the transcatheter approach for failed surgically-inserted aortic bioprostheses suggests that in high-risk patients having degenerated bioprosthetic valves, the VIV approach is clinically effective in most cases. While short- and intermediate-term results following these procedures are favorable, safety and efficacy concerns include device malposition, ostial coronary obstruction, and high post-procedural gradients. A larger trial with longer-term follow-up is indicated to further assess this novel technology.
Clinical Topics: Cardiac Surgery
Keywords: Heart Valve Prosthesis, Registries, Surgical Instruments, Follow-Up Studies, Bioprosthesis, New York, Postoperative Period
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