Key result
Valve-in-valve TAVR with surgical true-ID ≤21mm is linked to ~16 mmHg higher 1-year mean gradients.
Why the study?
Although VIV-TAVR provides good initial outcomes, lacking long-term durability data hinders expansion to lower-risk patients.
Does VIV-TAVR provide durable hemodynamic improvement and survival in patients with failed aortic bioprostheses?
Observational (n=77)
Does VIV-TAVR provide durable hemodynamic improvement and survival in patients with failed aortic bioprostheses?
Absolute Event Rate: 29.2% vs 13%
p-value: p=0.004
While VIV-TAVR is safe and effective early on, steadily increasing transvalvular gradients over 3 years raise concerns about long-term durability, particularly in smaller surgical valves.
3-year VIV-TAVR hemodynamics support use in high-risk patients; leaves open durability questions for lower-risk expansion.
Background VIV-TAVR is established and provides good initial clinical and hemodynamic outcomes. Lacking long-term durability data baffle the expand to lower risk patients. For those purposes, the present study adds a hemodynamic 3-years follow-up. Methods A total of 77 patients underwent VIV-TAVR for failing aortic bioprosthesis during a 7-years period. Predominant mode of failure was stenosis in 87.0%. Patients had a mean age of 79.4±5.8 years and a mean logistic EuroSCORE of 30.8±15.7%. The STS-PROM averaged 5.79±2.63%. Clinical results and hemodynamic outcomes are reported for 30-days, 1-, 2- and 3-years. Completeness of follow-up was 100% with 44 patients at risk after 3-years. Follow-up ranged up to 7.1 years. Results Majority of the surgical valves were stented (94.8%) with a mean labeled size of 23.1±2.3mm and true-ID of 20.4±2.6mm. A true-ID ≤21mm had 58.4% of the patients. Self-expanding valves were implanted in 68.8% (mean labeled size 24.1±1.8mm) and balloon-expanded in 31.2% (mean size 24.1±1.8mm). No patient died intraoperatively. Hospital mortality was 1.3% and three-years survival 57.1%. All patients experienced an initial significant dPmean-reduction to 16.8±7.1mmHg. After 3-years mean dPmean raised to 26.0±12.2mmHg. This observation was independent from true-ID or type of TAVR-prosthesis. Patients with a true-ID ≤21mm had a higher initial (18.3±5.3mmHg vs. 14.9±7.1mmHg; p=0.005) and dPmean after 1-year (29.2±8.2mmHg vs. 13.0±6.7mmHg; p=0.004). There were no significant differences in survival. Conclusions VIV-TAVR is safe and effective in the early period. In surgical valves with a true-ID≤21mm inferior hemodynamic and survival outcomes must be expected. Nonetheless, also patients with larger true-ID’s showed steadily increasing transvalvular gradients. This raises concern about durability.
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Wilbring et al. (2022) conducted an observational in Failing aortic bioprosthesis (n=77). Surgical valve true-ID ≤21mm vs. Surgical valve true-ID >21mm was evaluated on Mean transvalvular gradient (dPmean) at 1 year (p=0.004). Following valve-in-valve TAVR, a surgical valve true-ID ≤21mm was associated with significantly higher mean transvalvular gradients at 1 year compared to larger valves (29.2 vs 13.0 mmHg; p=0.004).
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