912 Valve-in-Valve Transcatheter Aortic Valve Implantation for Failing Aortic Valve Prostheses: an Australian Interventional Experience

Abstract

Valve-in-valve transcatheter aortic valve implantation (ViV-TAVI) is attractive in high risk re-do patients. To retrospectively analyse outcomes of ViV-TAVI procedures in a single centre. All patients who underwent ViV-TAVI between 02/2014 and 03/2020 at an Australian centre were examined in a retrospective cohort analysis. Valve characteristics, patient demographics, clinical data & outcomes were analysed. Twenty-nine patients were included (mean age 76 ±11, mean logistic Euroscore II 8.9±8.4). All patients had severe surgical bio-prosthetic failure necessitating consideration of re-do surgery (Perimount 14, Trifecta 3, Mosaic 6, Freestyle 4, Mitraflow 2). All patients had transfemoral access with Medtronic CoreValve/ Evolut valve (see table 1). Coronary protection was used in 3 patients with valve-to-coronary distances <4mm with stent removal due to good coronary flow post procedure. There were no deaths, strokes or incidences of coronary obstruction. 2 patients required permanent pacing (6.9%) 1 (3.4%) required surgical access site closure, 1 (3.4%) had re-do surgical replacement due to valve malposition and severe AR. ViV-TAVI offers excellent haemodynamic outcomes with low risk for patients who would otherwise undergo surgery.Table 1Echocardiographic outcomes and types of valve dysfunction.Pre procedurePost procedureAR n= 22Left ventricular end diastolic diameter (mm)54±1049.5±10Stroke volume indexed (mL/m2)41±2037±9Dimensionless index0.58±0.43AS and Mixed AS/AR n=7Aortic valve area (cm2)0.77±0.462.04±1.07Dimensionless index0.27±0.110.54±0.13 Open table in a new tab