Key result
Bail-out valve-in-valve TAVI linked to ~40% higher long-term mortality versus successful single-valve TAVI.
Why the study?
The in-hospital and long-term outcomes of bail-out valve-in-valve TAVI for primarily failed procedures compared with successful TAVI were not well established.
Does bail-out valve-in-valve TAVI during the index procedure affect long-term mortality compared to successful primary TAVI in patients undergoing transcatheter aortic valve replacement?
Cohort (n=231)
No
Does bail-out valve-in-valve TAVI during the index procedure affect long-term mortality compared to successful primary TAVI in patients undergoing transcatheter aortic valve replacement?
Bail-out valve-in-valve TAVI during the index procedure is a feasible alternative for failed primary TAVI, but it is associated with significantly increased long-term mortality and higher rates of periprocedural complications such as bleeding and new pacemaker implantation.
Warrants caution with bail-out ViV-TAVI; leaves open whether refined techniques or selection improve survival after failed primary TAVI.
OBJECTIVE: This study aimed to compare in-hospital and long-term outcomes of patients with bail-out valve-in-valve TAVI due to a primarily failed transcatheter aortic valves procedure (bViV-TAVI) versus a successful transcatheter aortic valve implantation (TAVI). METHODS: We recorded bViV-TAVI procedures at our center from February 2011 to March 2022. Primary endpoint was long-term mortality. In-hospital mortality, stroke, acute kidney failure, need for new permanent pacemaker, and duration of intervention were secondary endpoints. RESULTS: 4555 patients undergoing TAVI were retrospectively included. 231 matched (77:154) patients were analyzed. BViV-TAVI was a rare event (1.9%). In 76.7% of the cases transcatheter valve embolization and migration were the reasons for implanting a second valve in the same procedure. Significant PVL accounted for bViV-TAVI in 23.4% of the patients. The duration of the intervention was significantly longer for the bViV-TAVI group (p < 0.001). BViV-TAVI patients showed higher rates of a new permanent pacemaker implantation (p = 0.013) and the postprocedural mean pressure was significantly higher (p = 0.03). Concerning the other secondary endpoints there was a trend for a higher event rate in bVIV-TAVI patients which did not reach significant difference. After an average follow-up period of 4.9 ± 3.0 years, mortality was significantly higher in the bViV-TAVI group (54.5% vs. 39.0%, p = 0.025). CONCLUSION: The implantation of a second valve during the same procedure as bail-out is a feasible alternative treatment option in patients with failed transcatheter aortic valve procedures. However, increased long-term mortality must be taken into account.
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Horn et al. (2025) conducted a cohort in Failed transcatheter aortic valve procedure (n=231). Bail-out valve-in-valve TAVI (bViV-TAVI) vs. Successful single transcatheter aortic valve implantation (TAVI) was evaluated on Long-term all-cause mortality (p=0.025). Bail-out valve-in-valve TAVI during the index procedure was associated with significantly higher long-term all-cause mortality (54.5% vs. 39.0%) compared to successful single-valve TAVI.
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