Valve-in-valve TAVR in high-risk patients had a 1-year mortality of 12.4%, which significantly decreased from 19.7% in the initial registry to 9.8% in the continued access registry (p=0.006).
Observational (n=365)
Yes
Does valve-in-valve TAVR improve outcomes in high-risk patients with symptomatic degeneration of surgical aortic bioprostheses?
In high-risk patients with degenerated surgical aortic bioprostheses, valve-in-valve TAVR is associated with relatively low mortality and complication rates, and improved hemodynamics at 1 year.
BACKGROUND: Early experience with transcatheter aortic valve replacement (TAVR) within failed bioprosthetic surgical aortic valves has shown that valve-in-valve (VIV) TAVR is a feasible therapeutic option with acceptable acute procedural results. OBJECTIVES: The authors examined 30-day and 1-year outcomes in a large cohort of high-risk patients undergoing VIV TAVR. METHODS: Patients with symptomatic degeneration of surgical aortic bioprostheses at high risk (≥50% major morbidity or mortality) for reoperative surgery were prospectively enrolled in the multicenter PARTNER (Placement of Aortic Transcatheter Valves) 2 VIV trial and continued access registries. RESULTS: Valve-in-valve procedures were performed in 365 patients (96 initial registry, 269 continued access patients). Mean age was 78.9 ± 10.2 years, and mean Society of Thoracic Surgeons score was 9.1 ± 4.7%. At 30 days, all-cause mortality was 2.7%, stroke was 2.7%, major vascular complication was 4.1%, conversion to surgery was 0.6%, coronary occlusion was 0.8%, and new pacemaker insertion was 1.9%. One-year all-cause mortality was 12.4%. Mortality fell from the initial registry to the subsequent continued access registry, both at 30 days (8.2% vs. 0.7%, respectively; p = 0.0001) and at 1 year (19.7% vs. 9.8%, respectively; p = 0.006). At 1 year, mean gradient was 17.6 mm Hg, and effective orifice area was 1.16 cm CONCLUSIONS: In high-risk patients, TAVR for bioprosthetic aortic valve failure is associated with relatively low mortality and complication rates, improved hemodynamics, and excellent functional and quality-of-life outcomes at 1 year. (The PARTNER II Trial: Placement of AoRTic TraNscathetER Valves PARTNER II; NCT01314313).
Webb et al. (Mon,) conducted a observational in Symptomatic degeneration of surgical aortic bioprostheses at high risk for reoperative surgery (n=365). Valve-in-valve TAVR was evaluated on 1-year all-cause mortality. Valve-in-valve TAVR in high-risk patients had a 1-year mortality of 12.4%, which significantly decreased from 19.7% in the initial registry to 9.8% in the continued access registry (p=0.006).