Transcatheter aortic valve replacement for small failed surgical bioprosthesis

Background Data on the prognostic impact of small failed surgical bioprostheses following valve-in-valve (ViV) transcatheter aortic valve replacement (TAVR) remain limited. Purpose This study aimed to assess the mid-term outcomes of ViV TAVR for small failed surgical bioprostheses and evaluate the association of patient-prosthesis mismatch (PPM) on clinical outcomes. Additionally, predictors of severe PPM were identified. Methods We analyzed patients who underwent ViV TAVR for degenerated surgical bioprostheses in the OCEAN-TAVI registry. Patients were divided into 2 groups according to the true internal diameter (ID) of surgical bioprostheses: small bioprostheses (SB) group (ID ≤ 20mm) and non-small bioprostheses (NB) group (ID > 20mm). The primary endpoint was the composite of cardiovascular death or heart failure (HF) hospitalization at 3-years. Predictors of severe PPM (<0.65 cm2/m2) were also examined. Results A total of 367 consecutive patients undergoing ViV TAVR (SB: 244 patients vs. NB: 123 patients) were included. Thirty-day mortality was 0.5%. Severe PPM occurred in 16.9% of the entire cohort and was more prevalent in the SB group (SB: 21.3% vs. NB: 8.3%, p<0.01). The SB group had a higher risk of cardiovascular death or HF hospitalization at 3-years (SB group 19.1% vs NB group 9.8%, adjusted hazard ratio 3.47 [95% confidence interval, 1.11-10.86], p=0.01). The SB patients with severe PPM had the highest risk of the primary outcome. Predictors of severe PPM included higher body surface area, balloon-expandable valve implantation, and true ID≤20mm. Conclusions ViV TAVR for small surgical bioprostheses was associated with worse clinical outcome, particularly in those with severe PPM.Incidence of PPM Clinical Outcomes of ViV TAVR