Key result
Valve-in-valve transcatheter aortic valve implantation within stentless valves achieved 100% procedural success, with 4% in-hospital mortality and 8% requiring permanent pacemakers.
Why the study?
VIV-TAVI within stentless valves carries a higher complication rate than within stented valves due to challenging anatomy and lacking fluoroscopic landmarks.
Does valve-in-valve transcatheter aortic valve implantation (VIV-TAVI) provide safe and effective outcomes in patients with failing stentless aortic valves?
Cohort (n=25)
No
Does valve-in-valve transcatheter aortic valve implantation (VIV-TAVI) provide safe and effective outcomes in patients with failing stentless aortic valves?
VIV-TAVI within stentless valves can be performed safely with high procedural success and acceptable mid-term valve function in high-risk patients.
Supports VIV-TAVI feasibility in high-risk patients with failing stentless valves; extends observational data but leaves open need for RCTs.
BACKGROUND: Valve-in-valve (VIV) transcatheter aortic valve implantation (TAVI) is a less invasive therapeutic option compared with redo surgical valve replacement for high-risk patients. Relative to procedures within stented surgical valves, VIV-TAVI within stentless valves is associated with a higher complication rate due to challenging underlying anatomy and absence of fluoroscopic landmarks. AIMS: We share a single-center experience with VIV-TAVI in stentless valves, discussing our procedural insights and associated outcomes. METHODS: Our institutional database was queried, and 25 patients who had undergone VIV-TAVI within a stentless bioprosthesis, homograft, or valve-sparing aortic root replacement between 2013 and 2022 were found. Outcome endpoints were based on the Valve Academic Research Consortium-3 criteria. RESULTS: The mean age of the cohort was 69.5 ± 13.6 years. VIV implantation was performed within a homograft in 11 patients, a stentless bioprothesis in 10 patients, and a valve-sparing aortic root replacement in 4 patients. Nineteen (76%) balloon-expandable valves, 5 (20%) self-expanding valves, and one mechanically-expandable (4%) valve were implanted with 100% procedural success, with no instances of significant paravalvular leak, coronary occlusion, or device embolization. There was one (4%) in-hospitality mortality after an emergency procedure; one (4%) patient experienced a transient ischemic attack; and two (8%) patients required permanent pacemaker implantation. The median length of hospital stay was 2 days. After a median follow-up time of 16.5 months, valve function was acceptable in all patients with available data. CONCLUSION: VIV-TAVI within stentless valves can be safely performed with methodical procedural technique and can provide clinical benefit in patients at high reoperation risk.
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Lang et al. (2023) conducted a cohort in Patients requiring valve-in-valve transcatheter aortic valve implantation within stentless valves (n=25). Valve-in-valve transcatheter aortic valve implantation (VIV-TAVI) was evaluated on Procedural success (VARC-3 criteria). Valve-in-valve transcatheter aortic valve implantation within stentless valves achieved 100% procedural success, with 4% in-hospital mortality and 8% requiring permanent pacemakers.
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