Abstract

The Valve-in-Valve (ViV) technique is an established alternative for the treatment of structural bioprosthetic valve deterioration (SVD). Data describing the intermediate term follow up of patients treated with this approach is scarce. We report on our intermediate-term outcomes of patients with SVD in the Aortic position treated with ViV. Included were patients with symptomatic SVD in the aortic position valve who were treated by Valve in valve transcatheter aortic valve implantation (ViV-TAVI) during the years 2010-2019 in our center. Three main outcomes were examined during the follow up period: NYHA functional class, ViV-TAVI hemodynamic per echocardiography, and mortality. Our cohort consisted of 85 patients (mean age 78.8 ± 8.9 years). The indications for aortic ViV were: SVD isolated aortic stenosis in 37.6%, SVD isolated aortic regurgitation in 42.2% and combined valve pathology in 20.0%. Self-expandable and balloon-expandable devices were used in 73 (85.9%) and 12 (14.1%), respectively. Average follow up was 3.7 ± 2.4 years. 95 and 91% of patients were in NYHA functional class I/II at 1 and 5 year follow up respectively. At one year, the mean trans-aortic valve pressure was 15 ± 9 mmHg and rates of ≥ moderate aortic regurgitation were 3.7%. Mortality at one year was 8.6% (95% CI 2.3–14.4) and 31% (95% CI 16.5–42.5) at 5 years. ViV in the aortic position offers an effective and durable treatment option for patient with SVD, with low rates of all-cause mortality, excellent hemodynamic and improved functional capacity at intermediate follow up.

Highlights

  • Bioprosthetic surgical valve replacement for the treatment of native valve diseases is used extensively

  • We report on our clinical experience of treating patients with structural valve deterioration (SVD) in the aortic position using the ViV technique in our institution, aiming to provide insights into the clinical outcomes of these patients by providing intermediate-term follow up results

  • The main objective of our study was to report on the intermediate-term clinical outcomes of patients with SVD treated with ViV-Transcatheter aortic valve implantation (TAVI) from our all-comer perspective registry

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Summary

Introduction

Bioprosthetic surgical valve replacement for the treatment of native valve diseases is used extensively. The treatment of failed bioprosthetic valves has traditionally been open surgical valve replacement. Valve in valve transcatheter aortic valve implantation. Long Term ViV-TAVI Outcomes (ViV-TAVI) inside failed surgically implanted bio-prostheses has become a reliable and less invasive alternative to repeat surgery [3, 4]. We report on our clinical experience of treating patients with structural valve deterioration (SVD) in the aortic position using the ViV technique in our institution, aiming to provide insights into the clinical outcomes of these patients by providing intermediate-term follow up results. All-cause mortality was graphically plotted using Kaplan-Meier curves and compared between groups using the log rank test (unadjusted analysis). All TAVI-related data was registered in an electronic file and analyzed using the SPSS, version 25.0, software (SPSS, Chicago, Illinois)

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