title: Transcatheter aortic valve-in-valve implantation: clinical outcome as defined by VARC-2 and postprocedural valve dysfunction according to the primary mode of bioprosthesis failure.
abstract: OBJECTIVE
  The objectives of this study were to investigate: (1) the clinical outcome of transcatheter aortic valve-in-valve (VIV) implantation according to Valve Academic Research Consortium (VARC)-2 criteria; and (2) to determine whether postprocedural transvalvular gradients differ in patients with bioprosthesis regurgitation or stenosis as primary mode of failure.
  
  
  BACKGROUND
  Transcatheter aortic VIV implantation has become a feasible option for selected high-risk patients with failed aortic surgical bioprostheses.
  
  
  METHODS
  Transcatheter aortic VIV implantation was performed in 14 high-risk individuals at the University of Zurich and University College London.
  
  
  RESULTS
  The prosthesis was successfully implanted in 13 patients (93%). In 1 patient, a second transcatheter valve needed to be implanted due to valve malpositioning. Thirty-day all-cause mortality was 7% (1/14). Prosthetic valve dysfunction according to VARC-2 at 30 days was observed in 7/14 patients (50%) due to an increased postprocedural transvalvular gradient >20 mm Hg. Preprocedural transaortic gradients correlated significantly with postprocedural gradients (r=0.91; P<.001). At 30-day follow-up, postprocedural gradients were higher in patients with aortic stenosis as primary mode of failure as compared to those with aortic regurgitation (36 ± 6 mm Hg vs 16 ± 4 mm Hg; P=.01). None of the patients exhibited prosthetic valve regurgitation of more than mild degree.
  
  
  CONCLUSIONS
  The feasibility and safety of VIV implantation in failed aortic bioprostheses is demonstrated. A higher postprocedural gradient was observed after VIV implantation in patients with aortic stenosis as compared to regurgitation as primary mode of failure.
authors.affiliation: Department of Cardiology, Cardiovascular Center, University Hospital Zürich, Rämistrasse 100, 8091 Zürich, Switzerland. ulf.landmesser@usz.ch.
authors.forename: Barbara E
authors.initials: BE
authors.lastname: Stähli
authors.forename: Markus
authors.initials: M
authors.lastname: Reinthaler
authors.forename: Thi Dan Linh
authors.initials: TD
authors.lastname: Nguyen-Kim
authors.forename: Catherine
authors.initials: C
authors.lastname: Gebhard
authors.forename: Hanna
authors.initials: H
authors.lastname: Tasnady
authors.forename: Jürg
authors.initials: J
authors.lastname: Grünenfelder
authors.forename: Volkmar
authors.initials: V
authors.lastname: Falk
authors.forename: Roberto
authors.initials: R
authors.lastname: Corti
authors.forename: Thomas
authors.initials: T
authors.lastname: Frauenfelder
authors.forename: Thomas F
authors.initials: TF
authors.lastname: Lüscher
authors.forename: Willibald
authors.initials: W
authors.lastname: Maier
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Mullen
authors.forename: Ulf
authors.initials: U
authors.lastname: Landmesser
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001705:Bioprosthesis; D005240:Feasibility Studies; D005260:Female; D006785:Hospitals, University; D006801:Humans; D008131:London; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology* / Q000601:surgery*; D011475:Prosthesis Failure; D012086:Reoperation / Q000401:mortality; D012106:Research; D013557:Switzerland; D065467:Transcatheter Aortic Valve Replacement / Q000379:methods* / Q000401:mortality; D016896:Treatment Outcome