Transcatheter aortic valve replacement for degenerative bioprosthetic surgical valves: results from the global valve-in-valve registry.
BACKGROUND
Transcatheter aortic valve-in-valve implantation is an emerging therapeutic alternative for patients with a failed surgical bioprosthesis and may obviate the need for reoperation. We evaluated the clinical results of this technique using a large, worldwide registry.


RESULTS
The Global Valve-in-Valve Registry included 202 patients with degenerated bioprosthetic valves (aged 77.7±10.4 years; 52.5% men) from 38 cardiac centers. Bioprosthesis mode of failure was stenosis (n=85; 42%), regurgitation (n=68; 34%), or combined stenosis and regurgitation (n=49; 24%). Implanted devices included CoreValve (n=124) and Edwards SAPIEN (n=78). Procedural success was achieved in 93.1% of cases. Adverse procedural outcomes included initial device malposition in 15.3% of cases and ostial coronary obstruction in 3.5%. After the procedure, valve maximum/mean gradients were 28.4±14.1/15.9±8.6 mm Hg, and 95% of patients had ≤+1 degree of aortic regurgitation. At 30-day follow-up, all-cause mortality was 8.4%, and 84.1% of patients were at New York Heart Association functional class I/II. One-year follow-up was obtained in 87 patients, with 85.8% survival of treated patients.


CONCLUSIONS
The valve-in-valve procedure is clinically effective in the vast majority of patients with degenerated bioprosthetic valves. Safety and efficacy concerns include device malposition, ostial coronary obstruction, and high gradients after the procedure.
Washington Hospital Center, 110 Irving St NW, Suite 4B-1, Washington, DC 20010, USA. danny.dvir@gmail.com
Danny
D
Dvir
John
J
Webb
Stephen
S
Brecker
Sabine
S
Bleiziffer
David
D
Hildick-Smith
Antonio
A
Colombo
Fleur
F
Descoutures
Christian
C
Hengstenberg
Neil E
NE
Moat
Raffi
R
Bekeredjian
Massimo
M
Napodano
Luca
L
Testa
Thierry
T
Lefevre
Victor
V
Guetta
Henrik
H
Nissen
José-María
JM
Hernández
David
D
Roy
Rui C
RC
Teles
Amit
A
Segev
Nicolas
N
Dumonteil
Claudia
C
Fiorina
Michael
M
Gotzmann
Didier
D
Tchetche
Mohamed
M
Abdel-Wahab
Federico
F
De Marco
Andreas
A
Baumbach
Jean-Claude
JC
Laborde
Ran
R
Kornowski
D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000453:epidemiology / Q000209:etiology / Q000601:surgery; D001024:Aortic Valve Stenosis / Q000453:epidemiology / Q000209:etiology / Q000601:surgery; D001705:Bioprosthesis / Q000009:adverse effects*; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000379:methods; D004868:Equipment Failure / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D014943:Global Health / Q000706:statistics & numerical data*; D006350:Heart Valve Prosthesis / Q000009:adverse effects*; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D015994:Incidence; D008297:Male; D012042:Registries; D012086:Reoperation; D012189:Retrospective Studies; D016896:Treatment Outcome