title: Early and Midterm Clinical and Hemodynamic Outcomes of Transcatheter Valve-in-Valve Implantation: Results From a Multicenter Experience.
abstract: BACKGROUND
  Transcatheter valve-in-valve (VIV) implantation is an alternative option in inoperable or high-risk patients with prosthetic valve dysfunction. Aim of this retrospective multicenter study was to evaluate early and midterm clinical and hemodynamic outcomes of patients undergoing aortic (VIV-A) and mitral VIV (VIV-M).
  
  
  METHODS
  We analyzed data of 66 procedures performed in 65 patients who underwent VIV procedures in the VIV-A and VIV-M position at 5 Italian institutions from January 2008 to May 2015. VIV-A and VIV-M were 44 (68%) and 22 (32%), respectively; 1 patient underwent combined mitroaortic VIV. Study devices were both balloon-expandable and self-expandable. Outcomes were defined according to the updated Valve Academic Research Consortium definitions.
  
  
  RESULTS
  Overall all-cause 30-day mortality was 6% (4 patients), and it was 4.5% and 9% in VIV-A and VIV-M, respectively (2 patients in each group). Mean follow-up was 14 ± 14 months. Kaplan-Meier survival of the entire cohort at 1, 2, 3, and 4 years was 84.4% ± 4.9%, 80.5% ± 6%, 74.3 ± 8.1%, and 62% ± 13.2%, respectively. Age (hazard ratio: 1.1; 95% confidence interval: 1.0 to 1.3; p = 0.035) and diabetes (hazard ratio: 7.2, 95% confidence interval: 2.1 to 23.7; p = 0.001) were identified as independent predictors of mortality. Degenerated surgical aortic prostheses with an internal diameter (ID) less than 20 mm had significantly higher gradients if compared to prostheses with ID 21 to 23 mm and greater than 23 mm. After VIV-A, a severe stenosis (mean gradient greater than 35 mm Hg) was detected in 3 (6.8%) cases, all with ID less than 20 mm.
  
  
  CONCLUSIONS
  VIV provides good early and midterm results in high-risk or inoperable patients with mitral or aortic bioprosthesis dysfunction. Age and diabetes are independently associated with mortality. Size of bioprosthesis ID has a significant impact on postoperative gradients.
authors: Division of Cardiac Surgery, University of Padova, Padova, Italy. Electronic address: adonofrio@hotmail.it.
authors: Augusto
authors: A
authors: D'Onofrio
authors: Division of Cardiac Surgery, University of Padova, Padova, Italy.
authors: Erjon
authors: E
authors: Tarja
authors: Division of Cardiac Surgery, University of Padova, Padova, Italy.
authors: Laura
authors: L
authors: Besola
authors: Division of Cardiac Surgery, San Camillo Hospital, Rome, Italy.
authors: Giampaolo
authors: G
authors: Luzi
authors: Centro Cardiologico Monzino, University of Milan, Milan, Italy.
authors: Marco
authors: M
authors: Agrifoglio
authors: Division of Cardiac Surgery, San Matteo Hospital, University of Pavia, Pavia, Italy.
authors: Marco
authors: M
authors: Aiello
authors: Division of Cardiac Surgery, Hesperia Hospital, Modena, Italy.
authors: Davide
authors: D
authors: Gabbieri
authors: Division of Cardiology, University of Padova, Padova, Italy.
authors: Giuseppe
authors: G
authors: Tarantini
authors: Division of Cardiac Surgery, University of Padova, Padova, Italy.
authors: Giulio
authors: G
authors: Rizzoli
authors: Division of Cardiac Surgery, San Camillo Hospital, Rome, Italy.
authors: Francesco
authors: F
authors: Musumeci
authors: Division of Cardiac Surgery, University of Padova, Padova, Italy.
authors: Gino
authors: G
authors: Gerosa
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001705:Bioprosthesis / Q000009:adverse effects; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000453:epidemiology; D004868:Equipment Failure; D005500:Follow-Up Studies; D006349:Heart Valve Diseases / Q000453:epidemiology / Q000601:surgery; D006350:Heart Valve Prosthesis / Q000009:adverse effects; D019918:Heart Valve Prosthesis Implantation; D006439:Hemodynamics; D006801:Humans; D007558:Italy / Q000453:epidemiology; D053208:Kaplan-Meier Estimate; D008943:Mitral Valve / Q000601:surgery; D011183:Postoperative Complications / Q000453:epidemiology; D011474:Prosthesis Design; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology; D012086:Reoperation / Q000379:methods* / Q000706:statistics & numerical data; D012307:Risk Factors; D065467:Transcatheter Aortic Valve Replacement / Q000706:statistics & numerical data; D016896:Treatment Outcome