Key result
Patients with rheumatic heart disease undergoing transcatheter valve-in-valve procedures had a higher 30-day mortality rate compared to non-rheumatic patients (21.7% vs. 5.4%, OR 4.861), although mid-term mortality was similar.
Why the study?
Bioprosthetic valves have limited durability especially in rheumatic heart disease patients who often undergo multiple redo surgeries, but data on transcatheter valve-in-valve implantation in this population are lacking.
Does transcatheter valve-in-valve implantation yield similar device success and clinical outcomes in patients with rheumatic versus non-rheumatic severe bioprosthetic valve dysfunction?
Observational (n=106)
No
Does transcatheter valve-in-valve implantation yield similar device success and clinical outcomes in patients with rheumatic versus non-rheumatic severe bioprosthetic valve dysfunction?
Odds Ratio: 4.861 (95% CI 1.047–22.573)
Absolute Event Rate: 21.7% vs 5.4%
p-value: p=0.044
Transcatheter valve-in-valve implantation is a feasible alternative to redo surgery for patients with rheumatic heart disease and severe bioprosthetic valve dysfunction, showing similar mid-term mortality to non-rheumatic patients despite a higher baseline risk profile.
Background: Bioprosthetic heart valve has limited durability and lower long-term performance especially in rheumatic heart disease (RHD) patients that are often subject to multiple redo operations. Minimally invasive procedures, such as transcatheter valve-in-valve (ViV) implantation, may offer an attractive alternative, although data is lacking. The aim of this study was to evaluate the baseline characteristics and clinical outcomes in rheumatic vs. non-rheumatic patients undergoing ViV procedures for severe bioprosthetic valve dysfunction. Methods: Single center, prospective study, including consecutive patients undergoing transcatheter ViV implantation in aortic, mitral and tricuspid position, from May 2015 to September 2020. RHD was defined according to clinical history, previous echocardiographic and surgical findings. Results: Among 106 patients included, 69 had rheumatic etiology and 37 were non-rheumatic. Rheumatic patients had higher incidence of female sex (73.9 vs. 43.2%, respectively; p = 0.004), atrial fibrillation (82.6 vs. 45.9%, respectively; p < 0.001), and 2 or more prior surgeries (68.1 vs. 32.4%, respectively; p = 0.001). Although, device success was similar between groups (75.4 vs. 89.2% in rheumatic vs. non-rheumatic, respectively; p = 0.148), there was a trend toward higher 30-day mortality rates in the rheumatic patients (21.7 vs. 5.4%, respectively; p = 0.057). Still, at median follow-up of 20.7 [5.1–30.4] months, cumulative mortality was similar between both groups ( p = 0.779). Conclusion: Transcatheter ViV implantation is an acceptable alternative to redo operations in the treatment of patients with RHD and severe bioprosthetic valve dysfunction. Despite similar device success rates, rheumatic patients present higher 30-day mortality rates with good mid-term clinical outcomes. Future studies with a larger number of patients and follow-up are still warranted, to firmly conclude on the role transcatheter ViV procedures in the RHD population.
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Lopes et al. (2021) conducted an observational in Severe bioprosthetic valve dysfunction (n=106). Rheumatic heart disease etiology vs. Non-rheumatic valvular heart disease etiology was evaluated on 30-day mortality (OR 4.861, 95% CI 1.047-22.573, p=0.044). Patients with rheumatic heart disease undergoing transcatheter valve-in-valve procedures had a higher 30-day mortality rate compared to non-rheumatic patients (21.7% vs. 5.4%, OR 4.861), although mid-term mortality was similar.
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