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03.05.2019 | Original Article | Ausgabe 12/2019

General Thoracic and Cardiovascular Surgery 12/2019

Early outcomes of transcatheter aortic valve implantation for degenerated aortic bioprostheses in Japanese patients: insights from the AORTIC VIV study

General Thoracic and Cardiovascular Surgery > Ausgabe 12/2019
Kizuku Yamashita, Satsuki Fukushima, Yusuke Shimahara, Yasuhiro Hamatani, Hideaki Kanzaki, Tetsuya Fukuda, Chisato Izumi, Satoshi Yasuda, Junjiro Kobayashi, Tomoyuki Fujita
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The online version of this article (https://​doi.​org/​10.​1007/​s11748-019-01133-3) contains supplementary material, which is available to authorized users.

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The valve-in-valve procedure, in which a transcatheter heart valve (THV) is implanted into a degenerated bioprosthetic valve, is standardized for high-risk patients. However, this procedure is challenging in Japanese patients who have a small aortic annulus. We investigated the feasibility, safety, and therapeutic efficacy of the valve-in-valve procedure involving a degenerated stented bioprosthesis, stentless bioprosthesis, or THV.


We performed a single-center, non-comparative study of the aortic valve-in-valve procedure (AORTIC VIV study). Beginning in October 2016, the aortic valve-in-valve procedure was performed in seven patients with a stented bioprosthesis, in three patients with a stentless bioprosthesis, and in one patient with a THV.


No 30-day post-procedure mortality or severe morbidities occurred. The mean echocardiographic gradient in the aortic position improved from 41 (38–48) to 17 (11–22) mmHg at 30 days (p = 0.01). No paravalvular or mild and more transvalvular leaks were detected. The New York Heart Association functional class improved from 2 (2–2.5) to 1 (1–1) at 30 days postoperatively (p = 0.01). Although the procedure failed in two patients with an implanted stentless bioprosthesis, the third patient with a stentless bioprosthesis and the one patient with a degenerated THV successfully underwent the valve-in-valve procedure.


Feasibility, safety, and potential efficacy of the aortic valve-in-valve procedure were confirmed in selected Japanese patients with a degenerated aortic bioprosthesis. The valve-in-valve procedure for stentless bioprostheses was technically challenging.

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