Two‐year outcomes after transcatheter aortic valve‐in‐valve implantation in degenerated surgical valves

• Published in: Catheterization and cardiovascular interventions 2022-11, Vol.100 (5), p.860-867
• Main Authors: Abushouk, Abdelrahman I., Abdelfattah, Omar, Gad, Mohamed M., Saad, Anas, Hariri, Essa, Isogai, Toshiaki, Shekhar, Shashank, Reed, Grant W., Puri, Rishi, Yun, James, Vargo, Patrick R., Weiss, Aaron J., Burns, Daniel, Unai, Shinya, Popovic, Zoran, Harb, Serge C., Krishnaswamy, Amar, Svensson, Lars G., Johnston, Douglas R., Kapadia, Samir R.
• Format: Article
• Language: English
• Subjects: Aortic valve; Congestive heart failure; Hemodynamics; Mortality; Patients; Rheumatic heart disease; structural valve deterioration; TAVI; valve‐in‐valve
• ISSN: 1522-1946; 1522-726X
• DOI: 10.1002/ccd.30388

Background Transcatheter aortic valve‐in‐valve implantation (ViV‐TAVI) has emerged in recent years as a safe alternative to redo surgery in high‐risk patients. Although early results are encouraging, data beyond short‐term outcomes are lacking. Herein, we aimed to assess the 2‐year outcomes after ViV‐TAVI. Methods Patients undergoing ViV‐TAVI for degenerated surgical valves between 2013 and 2019 at the Cleveland Clinic were reviewed. The coprimary endpoints were all‐cause mortality and congestive heart failure (CHF) hospitalizations. We used time‐to‐event analyses to assess the primary outcomes. Further, we measured the changes in transvalvular gradients and the incidence of structural valve deterioration (SVD). Results One hundred and eighty‐eight patients were studied (mean age = 76 years; 65% males). At 2 years of follow‐up, all‐cause mortality and CHF hospitalizations occurred in 15 (8%) and 28 (14.9%) patients, respectively. On multivariable analysis, the postprocedural length of stay was a significant predictor for both all‐cause mortality (hazard ratio [HR] = 1.1; 95% confidence interval [CI]: 1.01, 1.19) and CHF hospitalization (HR = 1.16; 95% CI: 1.07, 1.27). However, the internal diameter of the surgical valve was not associated with significant differences in both primary endpoints. For hemodynamic outcomes, nine patients (4.8%) developed SVD. The mean and peak transvalvular pressure gradients remained stable over the follow‐up period. Conclusion ViV‐TAVI for degenerated surgical valves was associated with favorable 2‐year clinical and hemodynamic outcomes. Further studies are needed to better understand the role of ViV‐TAVI as a treatment option in the life management of aortic valve disease.