Valve–in–valve Transcatheter Aortic Valve Replacement: El Dorado or Exit–strategy?

Abstract Introduction The Valve–in–Valve Transcatheter Aortic Valve Replacement (ViV–TAVR) procedure is a valid alternative treatment to surgery. Aim This study evaluates, from a clinical and echocardiographic point of view, the immediate and one–year postprocedural outcome of the ViV–TAVR in case of dysfunction of a biological prosthesis at the aortic site. Materials and Methods Between 2021 and 2022, 17 consecutive patients with stenosis (64.71%) or aortic valve insufficiency (35.29%) underwent ViV–TAVR procedure and we evaluated them echocardiographically for 12 months. Results The implanted valves (10 of 20 mm, 5 of 23 mm, 1 of 26 mm and one of 29 mm in diameter) were Sapien XT type in 4 patients and Sapien 3 in 13 cases (of which 3 Ultra). We reported the Kaplan–Meier curve referring to one–year mortality in the presence/absence of coronary heart disease. Degeneration of bioprostheses in patients aged ≤ 70 years at the time of implantation occurred on average in 10.89±2.98 years, in patients aged 70 years in 7.88±2.23 years after implantation intervention. For all patients we calculated the mean change in end–diastolic volume (EDV) between the value at baseline, immediately after ViV–TAVR and at one–year follow–up. On patients who had bioprosthesis dysfunction with stenosis, we calculated the change in the mean transvalvular gradient (Gm) and Doppler Velocity Index (DVi) at baseline, immediately after ViV–TAVR and at follow–up. Conclusions The analyzed echocardiographic parameters were improved after ViV–TAVR both in the immediate post–procedural and in the follow–up period.