title: Early clinical outcome of aortic transcatheter valve-in-valve implantation in the Nordic countries.
abstract: OBJECTIVE
  Transcatheter valve-in-valve implantation has emerged as an option, in addition to reoperative surgical aortic valve replacement, to treat failed biologic heart valve substitutes. However, the clinical experience with this approach is still limited. We report the comprehensive experience of transcatheter valve-in-valve implantation in the Nordic countries from May 2008 to January 2012.
  
  
  METHODS
  A total of 45 transcatheter aortic valve-in-valve implantations were performed during the study period in 11 centers. The mean age of the patients was 80.6 years (range, 61-91), 26 were male and 19 were female, and the mean EuroSCORE, EuroSCORE II, and Society of Thoracic Surgeons score was 35.4, 16.3, and 14.6, respectively. The type of failure was stenosis and combined in 58% (mean and peak aortic valve gradient, 77 and 45 mm Hg, respectively) and regurgitation in 42% of cases. The SAPIEN/XT (Edwards LifeSciences, Irvine, Calif) and CoreValve (Medtronic Inc, Minneapolis, Minn) system was used in 33 and 12 cases, respectively. The access route was transapical in 25, transfemoral in 17, transaortic in 2, and subclavian in 1 case. The mean follow-up was 14.4 months. The periprocedural and postoperative outcomes were assessed using the Valve Academic Research Consortium criteria.
  
  
  RESULTS
  No intraprocedural mortality occurred. The technical success rate was 95.6% (1 second valve implantation, 1 conversion to open surgery). The all-cause 30-day mortality was 4.4% (1 cardiac-related and 1 aspiration pneumonia). The major complications within 30 days included stroke in 2.2%, periprocedural myocardial infarction in 4.4%, and major vascular complication in 2.2% of patients. At 1 month, all but 1 patient had either no or mild paravalvular leakage, with a mean and peak valve gradient of 17 mm Hg (range, 4-38) and 30 mm Hg (range, 7-68), respectively. The mean gradient was greater than 20 mm Hg in 17% of patients and remained unchanged at 12 months. The 1-year survival was 88.1%.
  
  
  CONCLUSIONS
  Transcatheter valve-in-valve implantation is widely performed, albeit in small numbers, in most centers in the Nordic countries. The short-term results were excellent in this high-risk patient population, demonstrating a low incidence of device- or procedure-related complications. However, a considerable number of patients were left with suboptimal systolic valve performance with unknown long-term effects, warranting close surveillance after transcatheter valve-in-valve implantation.
authors.affiliation: Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland. Electronic address: leo.ihlberg@hus.fi.
authors.forename: Leo
authors.initials: L
authors.lastname: Ihlberg
authors.forename: Henrik
authors.initials: H
authors.lastname: Nissen
authors.forename: Niels-Erik
authors.initials: NE
authors.lastname: Nielsen
authors.forename: Andreas
authors.initials: A
authors.lastname: Rück
authors.forename: Rolf
authors.initials: R
authors.lastname: Busund
authors.forename: Kaj-Erik
authors.initials: KE
authors.lastname: Klaarborg
authors.forename: Lars
authors.initials: L
authors.lastname: Soendergaard
authors.forename: Jan
authors.initials: J
authors.lastname: Harnek
authors.forename: Heikki
authors.initials: H
authors.lastname: Miettinen
authors.forename: Markku
authors.initials: M
authors.lastname: Eskola
authors.forename: Alexander
authors.initials: A
authors.lastname: Wahba
authors.forename: Mika
authors.initials: M
authors.lastname: Laine
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation; D005260:Female; D005387:Finland; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D011475:Prosthesis Failure; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D012537:Scandinavian and Nordic Countries; D013997:Time Factors; D016896:Treatment Outcome
keywords: 28.1; 35.2; 35.3.5; ID; TAVI; TEE; THV; VinV; internal diameter; transcatheter aortic valve implantation; transcatheter heart valve; transesophageal echocardiography; valve-in-valve