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12.07.2018 | Original Paper

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

Zeitschrift:
Clinical Research in Cardiology
Autoren:
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
Wichtige Hinweise
The original version of this article was revised: The spelling of the eleventh author’s name is “Frederik Beckhoff”.
Bernhard Wernly and Ann-Katrin Zappe contributed equally.
A correction to this article is available online at https://​doi.​org/​10.​1007/​s00392-018-1350-z.

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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