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12.07.2018 | Original Paper

Transcatheter valve-in-valve implantation (VinV-TAVR) for failed surgical aortic bioprosthetic valves

verfasst von: Bernhard Wernly, Ann-Katrin Zappe, Axel Unbehaun, Jan-Malte Sinning, Christian Jung, Won-Keun Kim, Stephan Fichtlscherer, Michael Lichtenauer, Uta C. Hoppe, Brunilda Alushi, Frederik Beckhoff, Charlotte Wewetzer, Marcus Franz, Daniel Kretzschmar, Eliano Navarese, Ulf Landmesser, Volkmar Falk, Alexander Lauten

Erschienen in: Clinical Research in Cardiology | Ausgabe 1/2019

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Abstract

Objective

We sought to investigate the procedural and hemodynamic outcome after valve-in-valve transcatheter aortic valve replacement (VinV-TAVR) for different surgical (SBV) and transcatheter (TAVR) bioprosthetic valves.

Methods and results

223 patients (76 ± 11years, STS-Score 8.3 ± 10.1) suffering from SBV failure treated with VinV-TAVR were enrolled at 6 centers across Germany. At time of the intervention, the majority of patients were in NYHA-class ≥ III (88%, n = 180). Failure mode of the SBVs was either stenosis, regurgitation (AR) or a combination of both in 85 (38%), 76 (34%) and 62 (28%) patients, respectively. 138 (62%) patients were treated with first generation TAVR valves (Edwards Sapien XT or CoreValve). Second generation valves were implanted in 85 (38%) patients (Sapien 3, Medtronic CoreValve Evolut, SJM-Portico, JenaValve). VinV-TAVR was associated with high procedural success rate, conversion to surgery was necessary in 3 (2%) patients. After VinV-TAVR procedure, 4 (2%) patients suffered from ≥ moderate AR. In 6 (3%) patients a second valve was implanted due to mispositioning of the first valve and subsequent severe paravalvular AR. Coronary obstruction was observed in 4 (2%) patients. Major bleeding and cerebrovascular complications (according to VARC) were reported in 3 (1%) and 4 (2%) patients at 30 days. Post-interventionally, 44/178 (25%) patients evidenced a mean pressure gradient (mPG) ≥ 20 mmHg. Residual stenosis was not associated with increased mortality (HR 0.39; 95% CI 0.13–1.22; p = 0.11).

Conclusion

In VinV-TAVR for SBV-failure is a safe procedure resulting in hemodynamic improvement in the majority of patients. Residual stenosis is a common finding which can be observed in 1/4 of patients undergoing VinV-TAVR. However, this condition is not associated with increased 1-year-mortality.

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Titel: Transcatheter valve-in-valve implantation (VinV-TAVR) for failed surgical aortic bioprosthetic valves
verfasst von: Bernhard Wernly
Ann-Katrin Zappe
Axel Unbehaun
Jan-Malte Sinning
Christian Jung
Won-Keun Kim
Stephan Fichtlscherer
Michael Lichtenauer
Uta C. Hoppe
Brunilda Alushi
Frederik Beckhoff
Charlotte Wewetzer
Marcus Franz
Daniel Kretzschmar
Eliano Navarese
Ulf Landmesser
Volkmar Falk
Alexander Lauten
Publikationsdatum: 12.07.2018
Verlag: Springer Berlin Heidelberg
Erschienen in: Clinical Research in Cardiology / Ausgabe 1/2019
Print ISSN: 1861-0684
Elektronische ISSN: 1861-0692
DOI: https://doi.org/10.1007/s00392-018-1326-z

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