title: Redo procedures for degenerated stentless aortic xenografts and the role of valve-in-valve transcatheter techniques.
abstract: This study evaluates reinterventions for degenerated stentless aortic xenografts.
  
  
  
  Between 2010 and 2015, 52 consecutive patients (age 72.3 ± 9.7 years, EuroSCORE II 11.1 ± 8.9%) underwent reintervention for failed stentless aortic valves (60% porcine, 40% pericardial, 87% sub-coronary, 81% isolated/combined regurgitation).
  
  
  
  Based on age, EuroSCORE II, the presence of pulmonary hypertension, renal failure, a patent internal mammary artery graft and required concomitant procedures, the heart team assigned 25 patients to reoperation and 27 to valve-in-valve transcatheter aortic valve implantation (ViV-TAVI). Valve implantation was successful in all surgical (24% root replacement) and in 24 transcatheter cases (93% trans-femoral, 56% balloon-expandable). Procedural complications were aortic dissection ( n  = 1) during reoperation and coronary obstruction ( n  = 4), device malpositioning ( n  = 3), deployment of >1 valve ( n  = 2) and vascular access site complications ( n  = 2) during ViV-TAVI. Thirty-day mortality (10%, three ViV-TAVI patients, two surgical patients, P  = 1.0) was associated with preoperative renal failure, >1 concomitant procedure, life-threatening bleeding, coronary obstruction and necessity for prolonged circulatory support. ViV-TAVI was beneficial regarding ventilation time, transfusion requirements and the incidence of sepsis. Overall, functional (94% New York Heart Association Class I/II) and echocardiographic results (indexed effective orifice area 0.95 ± 0.27 cm 2 /m 2 , mean transvalvular gradient 14 ± 6.8 mmHg) were favourable. After ViV-TAVI, aortic regurgitation was mild and moderate in two and three patients. One-year survival was 82.3 ± 5.4% and similar after surgery (83.1 ± 7.7%) and ViV-TAVI (81.5 ± 7.5%, P  = 0.76).
  
  
  
  Reinterventions for degenerated stentless aortic valves are challenging. Although ViV-TAVI is appropriate in high-risk patients, limitations and potential complications must be considered. Redo surgery has its place in low-risk patients and if concomitant procedures are required.
authors.affiliation: Department of Cardiovascular Surgery, Campus Charité Mitte, Charité - Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Herko
authors.initials: H
authors.lastname: Grubitzsch
authors.affiliation: Department of Cardiovascular Surgery, Campus Charité Mitte, Charité - Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Zobel
authors.affiliation: Department of Cardiovascular Surgery, Campus Charité Mitte, Charité - Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Torsten
authors.initials: T
authors.lastname: Christ
authors.affiliation: Department of Cardiovascular Surgery, Campus Charité Mitte, Charité - Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Holinski
authors.affiliation: Department of Cardiology, Campus Charité Mitte, Charité - Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Karl
authors.initials: K
authors.lastname: Stangl
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, Campus Charité Mitte, Charité - Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Sascha
authors.initials: S
authors.lastname: Treskatsch
authors.affiliation: Department of Cardiovascular Surgery, Campus Charité Mitte, Charité - Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Volkmar
authors.initials: V
authors.lastname: Falk
authors.affiliation: Department of Cardiology, Campus Charité Mitte, Charité - Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Laule
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000601:surgery; D001024:Aortic Valve Stenosis / Q000601:surgery; D001705:Bioprosthesis; D004452:Echocardiography; D005260:Female; D006350:Heart Valve Prosthesis; D006801:Humans; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D011474:Prosthesis Design; D011475:Prosthesis Failure; D012086:Reoperation / Q000379:methods; D015607:Stents; D065467:Transcatheter Aortic Valve Replacement / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome
keywords: Reoperation ; Stentless aortic xenograft ; Valve-in-valve transcatheter aortic valve implantation