Key result
Valve-in-valve TAVR in failed stentless valves had similar 30-day mortality to stented valves (6.9% vs 0%, P=0.33) but lower mean aortic gradients and higher need for a second valve (34.4% vs 0%).
Why the study?
Valve-in-valve TAVR is an alternative to surgical redo for bioprosthetic valve failure, but data on ViV in stentless surgical valves have been limited.
Does valve-in-valve TAVR in failed stentless surgical bioprosthetic valves have comparable outcomes to failed stented valves in patients requiring reintervention?
Cohort (n=40)
No
Does valve-in-valve TAVR in failed stentless surgical bioprosthetic valves have comparable outcomes to failed stented valves in patients requiring reintervention?
Absolute Event Rate: 6.9% vs 0%
p-value: p=0.33
Valve-in-valve TAVR in stentless bioprosthetic valves is feasible with excellent procedural success and lower post-procedural gradients compared to stented valves, though it carries a higher risk of requiring a second valve.
ViV TAVR in failed stentless valves may be feasible with lower gradients; observational data leaves open comparative effectiveness and durability versus stented valves.
OBJECTIVES: The objectives of this study were to compare short- and intermediate-term clinical outcomes, procedural complications, TAVR prosthesis hemodynamics, and paravalvular leak (PVL) in stentless and stented groups. BACKGROUND: Valve-in-valve (ViV) transcatheter aortic valve replacement (TAVR) is an alternative to surgical redo for bioprosthetic valve failure. There have been limited data on ViV in stentless surgical valves. METHODS: We retrospectively analyzed 40 patients who underwent ViV TAVR in prior surgical bioprosthetic valves at Wake Forest Baptist Medical Center from October 2014 to September 2017. Eighty percent (32/40) ViV TAVRs were in stentless, while 20% (8/40) were in stented bioprosthetic valves. RESULTS: The primary mode of bioprosthetic valve failure for ViV implantation in the stentless group was aortic insufficiency (78%, 25/32), while in the stented group was aortic stenosis (75%, 6/8). The ViV procedure success was 96.9% (31/32) in stentless group and 100% in stented group (8/8). There were no significant differences in all-cause mortality at 30 days between stentless and stented groups (6.9%, 2/31 versus 0%, 0/8, P = 0.33) and at 1 year (0%, 0/25 versus 0%, 0/5). In the stentless group, 34.4% (11/32) required a second valve compared to the stented group of 0% (0/8). There was a significant difference in the mean aortic gradient at 30-day follow-up (12.33 ± 6.33 mmHg and 22.63 ± 8.45 mmHg in stentless and stented groups, P < 0.05) and at 6-month follow-up (9.75 ± 5.07 mmHg and 24.00 ± 11.28 mmHg, P < 0.05), respectively. CONCLUSIONS: ViV in the stentless bioprosthetic aortic valve has excellent procedural success and intermediate-term results. Our study shows promising data that may support the application of TAVR in stentless surgical aortic valve. However, further and larger studies need to further validate our single center's experience.
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Choi et al. (2018) conducted a cohort in Bioprosthetic valve failure (n=40). Valve-in-valve TAVR in stentless surgical bioprosthetic valves vs. Valve-in-valve TAVR in stented surgical bioprosthetic valves was evaluated on All-cause mortality at 30 days (p=0.33). Valve-in-valve TAVR in failed stentless valves had similar 30-day mortality to stented valves (6.9% vs 0%, P=0.33) but lower mean aortic gradients and higher need for a second valve (34.4% vs 0%).
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