Outcomes of Valve-In-Valve Transcatheter Aortic Valve Replacement.

Structural valve degeneration (SVD) is increasingly seen given the higher rates of bioprosthetic heart valve (BHV) usage for surgical and transcatheter aortic valve replacement (TAVR). Valve-in-valve TAVR (VIV-TAVR) is an attractive alternate for patients who are otherwise at high risk for reoperative surgery. We compared patients undergoing VIV-TAVR and native-valve TAVR through a retrospective analysis of our institutional TVT database from 2013 to 2022. Patients undergoing either a native-valve TAVR or VIV-TAVR were included. VIV-TAVR was defined as TAVR in previous SAVR patients. Kaplan-Meier survival analysis was used to obtain survival estimates. A Cox proportional hazards regression model was used for the multivariable analysis of mortality. A total of 3532 patients underwent TAVR of which 198 (5.6%) underwent VIV-TAVR. Patients in the VIV-TAVR cohort were younger than native-valve TAVR patients (79.5 vs. 84 years, p<0.001) with comparable number of women and a higher STS risk score (6.28 vs 4.46, p<0.001). The VIV-TAVR cohort had a higher incidence of major vascular complications (2.5% vs. 0.8%, p=0.008) but less permanent pacemaker (PPM) placement (2.5% vs. 8.1%, p=0.004). The incidence of stroke was comparable between the groups (VIV-TAVR: 2.5% vs. Native-TAVR: 2.4%, p=0.911). The 30-day readmission rates (VIV-TAVR: 7.1% vs. Native-TAVR: 9%, p=0.348) as well as the in-hospital (VIV-TAVR: 2% vs. Native-TAVR: 1.4%, p=0.46) and overall (VIV-TAVR: 26.3% vs. Native-TAVR: 30.8%, p=0.18) mortality at a follow-up of 1.8 years (0.83-3.5) were comparable between the groups. Survival estimates were comparable between the groups (Log rank p=0.27). On multivariable cox regression analysis, VIV-TAVR was associated with decreased hazards of death (Hazard ratio (HR): 0.68 (0.5-0.9), p=0.02). In conclusion, ViV-TAVR is a feasible and safe strategy for high-risk patients with bioprosthetic valve failure. There may be potentially higher short-term morbidity with VIV-TAVR with no overt impact on survival.

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Déclaration de conflit d'intérêts

Declaration of competing interest All the authors wish to confirm that there are no known conflicts of interest associated with this publication and there has been no financial support for this work that could have influenced its outcome. IS receives institutional research support from Abbott, Atricure, Artivion, Boston Scientific, Edwards, Medtronic, Terumo Aortic. As mentioned above, these conflicts are unrelated to this article.