A Comparative monocentric prospective study of patients treated with TAVI Valve-in-Valve or with an aortic native valve at Rouen University Hospital: Immediate and long-term results

Abstract

TAVI (Transcatheter Aortic Valve Implantation) by valve-in-valve (ViV) procedure has developed as an alternative to surgical reintervention in the event of aortic bioprosthesis degeneration. The objective of our study is to describe the immediate results and long-term follow-up of patients treated with ViV at Rouen University Hospital. All patients who underwent a TAVI procedure in aortic position between January 2011 and May 2018 were included prospectively and comprehensively. A comparative study between ViV and TAVI procedures on native valve was performed. A total of 1164 patients were included including 61 ViV procedures. ViV patients had a mean age of 83.6 ± 5.46 years. In total, 88.6% of the patients were treated by the femoral route. Final mean trans-aortic gradient was significantly higher in the “ViV group” in comparison to the “Native Valve” group (18.7 ± 8.4 vs. 10.8 ± 4.5 mmHg; < 0.0001). In addition emergency cardiac surgery was required more frequently after ViV procedures (3.3% vs. 0.5%, P = 0.009) and there was a tendency for increased risk of coronary obstruction (4.9% vs 1.4%, P = 0.07). Only one patient in the ViV group experienced moderate degeneration at one year after the procedure without significant difference between the two groups (1.6% vs. 1.2%, P = 0.53). Long-term survival was comparable between the 2 groups ( P = 0.44). Mortality was lower when using a CoreValve® for ViV procedures (0% vs 9.1%, P = 0.01). Aortic ViV procedure is an attractive and less invasive alternative to conventional aortic valve replacement in elderly patients at high surgical risk presenting with bioprosthetic degeneration. ViV procedures expose patients to an increased risk of coronary occlusion.