Transcatheter Aortic Valve Replacement for a Degenerated Transcatheter Valve—A Single Center Experience
Background The transcatheter valve-in-valve treatment (TAV-in-TAV) of degenerated transcatheter aortic valves is becoming more relevant, as the use of transcatheter aortic valve replacement (TAVR) increases. We report our experience with TAV-in-TAV in patients with a degenerated transcatheter heart valve (THV).
Methods We retrospectively analyzed prospectively collected data from our designated TAVR database. Intraprocedural and intrahospital outcomes were reported.
Results Ten patients out of a total of 3,144 TAVR implantations since 2007 presented with a degenerated THV, among those six with an Edwards Sapien XT (Edwards Lifesciences, Irvine, California, United States) valve, treated with a Medtronic Evolut R (Medtronic, Dublin, Ireland) valve. Four patients had severe stenosis, one pure insufficiency, and five combined stenosis and insufficiency. Average time between initial implantation and re-intervention was 6.8 ± 1.3 years. The mean preoperative maximum and mean gradients were 54.2 ± 14.8 mm Hg and 31.6 ± 9.9 mm Hg, respectively. Nine patients underwent transfemoral and one patient underwent transaortic TAV-in-TAV. Mean procedural time was 86.2 ± 51.5 minutes. Post-implantation, the maximum and mean gradients decreased to 18 ± 6.9 mm Hg and 8.4 ± 3.2 mm Hg (16 ± 8 mm Hg and 6.4 ± 1.7 mm Hg in the Evolut-in-Sapien subgroup), respectively. The valve area increased from 0.98 ± 0.28 mm Hg to 1.72 ± 0.32 mm Hg (0.8 ± 0.07 mm Hg to 1.9 ± 0.16 mm Hg in the Evolut-in-Sapien subgroup). Two patients experienced a vascular complication. No further Valve Academic Research Consortium-2 criteria complications occurred during hospitalization.
Conclusion TAV-in-TAV resulted in low procedural and peri-procedural complication rates. In particular, the usage of a supra-annular valve resulted in excellent hemodynamic results. Larger studies are required to validate this observational data and to establish a protocol for this procedure.
Received: 25 August 2020
Accepted: 30 December 2020
24 February 2021 (online)
© 2021. Thieme. All rights reserved.
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
- 1 Dvir D, Webb JG, Bleiziffer S. et al; Valve-in-Valve International Data Registry Investigators. Transcatheter aortic valve implantation in failed bioprosthetic surgical valves. JAMA 2014; 312 (02) 162-170
- 2 Landes U, Webb JG, De Backer O. et al. Repeat transcatheter aortic valve replacement for transcatheter prosthesis dysfunction. J Am Coll Cardiol 2020; 75 (16) 1882-1893
- 3 Dvir D, Webb J, Brecker S. et al. Transcatheter aortic valve replacement for degenerative bioprosthetic surgical valves: results from the global valve-in-valve registry. Circulation 2012; 126 (19) 2335-2344
- 4 Webb JG, Dvir D. Transcatheter aortic valve replacement for bioprosthetic aortic valve failure: the valve-in-valve procedure. Circulation 2013; 127 (25) 2542-2550
- 5 Mercanti F, Rosseel L, Neylon A. et al. Chimney stenting for coronary occlusion during TAVR: insights from the Chimney Registry. JACC Cardiovasc Interv 2020; 13 (06) 751-761
- 6 Khan JM, Dvir D, Greenbaum AB. et al. Transcatheter laceration of aortic leaflets to prevent coronary obstruction during transcatheter aortic valve replacement: concept to first-in-human. JACC Cardiovasc Interv 2018; 11 (07) 677-689
- 7 Bleiziffer S, Erlebach M, Simonato M. et al. Incidence, predictors and clinical outcomes of residual stenosis after aortic valve-in-valve. Heart 2018; 104 (10) 828-834
- 8 Bleiziffer S, Simonato M, Webb JG. et al. Long-term outcomes after transcatheter aortic valve implantation in failed bioprosthetic valves. Eur Heart J 2020; 41 (29) 2731-2742
- 9 Webb JG, Mack MJ, White JM. et al. Transcatheter aortic valve implantation within degenerated aortic surgical bioprostheses: PARTNER 2 Valve-in-Valve Registry. J Am Coll Cardiol 2017; 69 (18) 2253-2262
- 10 Deeb GM, Chetcuti SJ, Reardon MJ. et al. 1-Year results in patients undergoing transcatheter aortic valve replacement with failed surgical bioprostheses. JACC Cardiovasc Interv 2017; 10 (10) 1034-1044
- 11 Erlebach M, Ruge H, Noebauer C. et al. Transcatheter treatment of balloon-expandable valve structural degeneration: a single-center case series. Thorac Cardiovasc Surg 2019; 67 (S 01): S1-S100