title: Transcatheter valve-in-valve replacement of degenerated bioprosthetic aortic valves: a single Australian Centre experience.
abstract: BACKGROUND
  Patients with degenerated surgical bioprosthetic valves may be at high risk for further surgery because of age, comorbidities and the difficulties of repeat procedures. Percutaneous valve-in-valve implantation offers what may be a simpler and safer procedure.
  
  
  METHODS
  From May 2009 to March 2014 at the Prince Charles Hospital 1625 patients underwent surgical aortic valve replacement while 262 underwent transcatheter aortic valve implantation. Twelve patients had valve-in-valve implants for degenerated bioprosthetic aortic valves.
  
  
  RESULTS
  These implants were deployed successfully without major valvular or paravalvular regurgitation. There were no periprocedural deaths, myocardial infarcts, neurological events or major vascular complications. Two patients died after 1624 and 1319days. Median survival for the remainder is 581days; they are stable with New York Heart Association class I/II functional status although 4 have a degree of patient-prosthesis mismatch, one has moderate aortic regurgitation and one required surgery for a late aortic dissection.
  
  
  CONCLUSIONS
  Transcatheter valve-in-valve implantation is safe and effective treatment for patients with failed bioprosthetic aortic valves for whom reoperation is considered to be hazardous.
authors.affiliation: Institute of Cardiovascular Diseases, Madras Medical Mission, Chennai 600 037, India; Department of Cardiology, Prince Charles Hospital, Queensland 4032, Australia.
authors.forename: Vijayakumar
authors.initials: V
authors.lastname: Subban
authors.affiliation: Department of Cardiology, Prince Charles Hospital, Queensland 4032, Australia.
authors.forename: Michael
authors.initials: M
authors.lastname: Savage
authors.affiliation: Department of Cardiology, Prince Charles Hospital, Queensland 4032, Australia; University of Queensland, Brisbane, Australia.
authors.forename: James
authors.initials: J
authors.lastname: Crowhurst
authors.affiliation: Department of Cardiology, Prince Charles Hospital, Queensland 4032, Australia.
authors.forename: Karl
authors.initials: K
authors.lastname: Poon
authors.affiliation: Department of Cardiology, Prince Charles Hospital, Queensland 4032, Australia.
authors.forename: Alexander
authors.initials: A
authors.lastname: Incani
authors.affiliation: Department of Cardiology, Holy Spirit Northside Hospital, Queensland 4032, Australia.
authors.forename: Constantine
authors.initials: C
authors.lastname: Aroney
authors.affiliation: Department of Cardiothoracic Surgery, Prince Charles Hospital, Queensland 4032, Australia.
authors.forename: Peter
authors.initials: P
authors.lastname: Tesar
authors.affiliation: Department of Cardiothoracic Surgery, Prince Charles Hospital, Queensland 4032, Australia.
authors.forename: Andrew
authors.initials: A
authors.lastname: Clarke
authors.affiliation: Department of Cardiology, Prince Charles Hospital, Queensland 4032, Australia.
authors.forename: Christopher
authors.initials: C
authors.lastname: Raffel
authors.affiliation: Department of Cardiology, Prince Charles Hospital, Queensland 4032, Australia; University of Queensland, Brisbane, Australia.
authors.forename: Dale
authors.initials: D
authors.lastname: Murdoch
authors.affiliation: Department of Cardiology, Prince Charles Hospital, Queensland 4032, Australia; University of Queensland, Brisbane, Australia.
authors.forename: David
authors.initials: D
authors.lastname: Platts
authors.affiliation: Department of Cardiology, Prince Charles Hospital, Queensland 4032, Australia; University of Queensland, Brisbane, Australia.
authors.forename: Darryl
authors.initials: D
authors.lastname: Burstow
authors.affiliation: Department of Cardiology, Prince Charles Hospital, Queensland 4032, Australia.
authors.forename: Ramakrishna
authors.initials: R
authors.lastname: Saireddy
authors.affiliation: Department of Cardiology, Prince Charles Hospital, Queensland 4032, Australia; University of Queensland, Brisbane, Australia. Electronic address: nick.bett@health.qld.au.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Bett
authors.affiliation: Department of Cardiology, Prince Charles Hospital, Queensland 4032, Australia; University of Queensland, Brisbane, Australia.
authors.forename: Darren L
authors.initials: DL
authors.lastname: Walters
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000503:physiopathology; D001024:Aortic Valve Stenosis / Q000601:surgery*; D001315:Australia; D001705:Bioprosthesis / Q000009:adverse effects; D006328:Cardiac Catheterization / Q000379:methods; D005260:Female; D006350:Heart Valve Prosthesis / Q000009:adverse effects*; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012086:Reoperation / Q000379:methods; D065467:Transcatheter Aortic Valve Replacement / Q000009:adverse effects*; D016896:Treatment Outcome
keywords: Aortic valve; Bioprosthesis failure; Heart valve prosthesis implantation