Changes of Patient Characteristics and Procedural Measures Over 10 Years in Aortic Valve-in-valve Procedures for Degenerated Surgical Bioprostheses

Background: Aortic valve-in-valve (ViV) procedures for treatment of degenerated surgical bioprostheses are an established therapy. However, several procedural refinements and changes have been implemented over the last decade. We herein evaluated how patients’ risk profiles, procedural approaches, and early outcomes in aortic ViV procedures changed over a period of 10 years.

Methods: Baseline, procedural, and 30-day outcome parameters of aortic ViV procedures for degenerated surgical aortic bioprotheses were retrospectively compared between three time periods (period 1: 2013–2016; period 2: 2017–2020; period 3: 2021–2023).

Results: Between 01/2013 and 12/2023, a total of 256 patients underwent aortic ViV with a steady increase of patient numbers (73 versus 80 versus 103 patients). Median age was 76.9 years; EuroSCORE II showed a significant shift toward lower risk profiles in period 2 and 3 (13.2 ± 10.4 versus 8.0 ± 6.2 versus 9.9 ± 9.5%; p = 0.001). Patients in later periods presented with lower percentages of NYHA functional class III or IV (89.0% versus 77.5% versus 66.0%, p = 0.004). Access routes changed significantly over time, with transfemoral access in 100% of patients in period 3 (p < 0.001). While in periods 1 and 2 most used transcatheter heart valves (THV) consisted of supra-annular self-expanding (SE) THV, a shift toward intraannular SE THV was seen in period 3. Procedure times were shorter in period 3 (111.6 ± 50.9 versus 124.9 ± 66.9 versus 90.0 ± 65.0 minutes, p < 0.001). Over time significantly more BASILICA procedures were performed (0% versus 17.5% versus 19.4%; p < 0.001), and rates of valve fracturing steadily increased (0% versus 6.3% versus 7.8%, p = 0.058). Length of intensive-care unit stay was significantly shorter in period 3 than in period 1 (2.2 ± 2.1 versus 1.6 ± 1.6 versus 1.8 ± 3.0 days, p < 0.001). Outcome parameters such as rates of permanent pacemaker implantation, bleeding, acute kidney injury disabling stroke (0.0% versus 1.3% versus 1.0%, p = 0.653), 30-day mortality (5.5% versus 3.8% versus 0.0%, p = 0.069), and device success (91.8% versus 92.5% versus 98.1%, p = 0.123) were without significant changes over time.

Conclusion: This 10-year study of aortic ViV procedures for degenerated bioprostheses showed significant changes in patients’ risk profile and procedural measures over time. Advancements in technical approaches have expanded the eligibility of patients for interventional treatment. Early outcomes such as device success, stroke, and 30-day mortality were excellent with improvement over time, highlighting the procedure’s clinical efficacy and safety.

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Artikel online veröffentlicht:
11. Februar 2025