Key result
Aortic valve-in-valve TAVI shows ~2% 1-year rate of death or stroke in lower-risk patients.
Why the study?
Transcatheter aortic valve implantation is safe and effective for high-risk patients with bioprosthetic valve failure, but had not been studied in low- and intermediate-risk patients.
Does aortic valve-in-valve transcatheter implantation improve clinical outcomes safely in low- and intermediate-risk patients with surgical bioprosthetic valve failure?
Cohort (n=100)
Yes
Does aortic valve-in-valve transcatheter implantation improve clinical outcomes safely in low- and intermediate-risk patients with surgical bioprosthetic valve failure?
Answers are grounded in this paper and cite their sources.
Aortic valve-in-valve transcatheter implantation is a safe and hemodynamically effective short-term option for low- and intermediate-risk patients with failing surgical bioprosthetic valves.
Background: Transcatheter aortic valve implantation is safe and effective for high-risk patients with bioprosthetic valve failure (BVF) but has not been studied in low- and intermediate-risk patients. One year outcomes of the PARTNER 3 Aortic Valve-in-valve (AViV) Study were evaluated. Methods: This prospective, single-arm, multicenter study enrolled 100 patients from 29 sites with surgical BVF. The primary endpoint was a composite of all-cause mortality and stroke at 1 year. The key secondary outcomes included mean gradient, functional capacity, and rehospitalization (valve-related, procedure-related, or heart failure related). Results: A total of 97 patients underwent AViV with a balloon-expandable valve from 2017 to 2019. Patients were 79.4% male with a mean age of 67.1 years and Society of Thoracic Surgeons score of 2.9%. The primary endpoint occurred in 2 patients (2.1%) who had strokes; there was no mortality at 1 year. Five patients (5.2%) had valve thrombosis events, and 9 patients (9.3%) had rehospitalizations, including 2 (2.1%) for strokes, 1 (1.0%) for heart failure, and 6 (6.2%) for aortic valve reinterventions (3 explants, 3 balloon dilations, and 1 percutaneous paravalvular regurgitation closure). From baseline to 1 year, New York Heart Association class III/IV decreased from 43.3% to 4.5%, mean gradient from 39.1 ± 18.2 mm Hg to 19.7 ± 7.6 mm Hg, and ≥moderate aortic regurgitation from 41.1% to 1.1%. Conclusions: AViV with a balloon-expandable valve improved hemodynamic and functional status at 1 year and can provide an additional therapeutic option in selected low- or intermediate-risk patients with surgical BVF, although longer term follow-up is necessary.
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Malaisrie et al. (2022) conducted a cohort in Surgical bioprosthetic aortic valve failure (n=100). Aortic valve-in-valve transcatheter implantation (balloon-expandable valve) was evaluated on Composite of all-cause mortality and stroke at 1 year. Transcatheter aortic valve-in-valve implantation in low- and intermediate-risk patients with bioprosthetic valve failure resulted in a 2.1% rate of the primary composite of all-cause mortality and stroke at 1 year.
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