1-year Outcomes Following TAVI for Degeneration of Aortic Root Surgery

Background: Transcatheter aortic valve implantation (TAVI) after previous aortic root surgery with failing native or prosthetic aortic valves is an alternative treatment option in patients at high risk for re-do cardiac surgery. However, reports on mid-term outcomes are scarce. We herein present our experience with this procedure including 1-year outcomes.

Methods: Between 2008 and 2023, 21 patients (86% male, 70.3 ± 10.4 years, EuroSCORE II 4.3 ± 2.8%) received TAVI after Bentall (11/21, 52.4%) procedure, David (5/21, 23.8%) procedure, surgical aortic valve replacement (SAVR) using full root stentless bioprosthesis (2/21, 9.5%), homograft implantation (1/21, 4.8%), and aortic root enlargement (ARE) with subsequent SAVR (1/21, 4.8%). Data were retrospectively analyzed according to VARC-3 definitions.

Results: TAVI was performed for aortic regurgitation in 18/21 patients and for severe aortic stenosis in 3/21 patients via transfemoral access in 19/21 (90.5%) and transapical access in 2/21 patients (9.5%). Implanted valves included Sapien in 13/21 cases (1/13 23 mm, 9/13 26 mm, 3/13 29 mm), Evolut in 5/21 cases (⅕ 23 mm, ⅖ 26 mm, ⅕ 29 mm, ⅕ 34 mm), one JenaValve (27 mm), one Portico (29 mm), and one Allegra transcatheter heart valve (23 mm). Device success, early safety, and technical success were 85.7% (18/21), 65.5% (17/21), and 85.7% (18/21) with resulting transvalvular mean pressure gradients of 12.9 ± 4.7 mm Hg and no paravalvular leakage >mild. Failure to reach the composite endpoints were due to two intraprocedural PCI of the left coronary artery (full root stentless bioprosthesis and Bentall, Mitroflow 23 mm), two permanent pacemaker implantations, and two transvalvular mean pressure gradient >20 mm Hg (SAVR with ARE, Sapien 26 in Perimount 25 mm and Bentall with Sapien 26 in Labcor 25 mm). 30-day and 1 year mortality was 0.0% (0/21) and 4.8% (1/21) due to malignancy. No stroke was observed. Intensive care unit and overall hospital stay were 1.3 ± 0.8 and 6.1 ± 1.5 days. Rehospitalization rate was 2/21 (9.5%) due to one covered ruptured LVOT (Allegra 23 mm in Freestyle 21 mm) and one case of gastrointestinal bleeding.

Conclusion: TAVI for failing aortic root surgery is safe, feasible, and presents adequate 1-year outcomes with absence of stroke and low rates of mortality and rehospitalization. Our results suggest, that for this particular subgroup of patients with increased procedural risks, such as coronary obstruction, meticulous planning and analysis of MSCT are required to minimize periprocedural risk.

Publication History

Article published online:
11 February 2025