Long-term outcomes after transcatheter aortic valve implantation in failed bioprosthetic valves

TY - JOUR

T1 - Long-term outcomes after transcatheter aortic valve implantation in failed bioprosthetic valves

AU - Bleiziffer, Sabine

AU - Simonato, Matheus

AU - Webb, John G

AU - Rodés-Cabau, Josep

AU - Pibarot, Philippe

AU - Kornowski, Ran

AU - Windecker, Stephan

AU - Erlebach, Magdalena

AU - Duncan, Alison

AU - Seiffert, Moritz

AU - Unbehaun, Axel

AU - Frerker, Christian

AU - Conzelmann, Lars

AU - Wijeysundera, Harindra

AU - Kim, Won-Keun

AU - Montorfano, Matteo

AU - Latib, Azeem

AU - Tchetche, Didier

AU - Allali, Abdelhakim

AU - Abdel-Wahab, Mohamed

AU - Orvin, Katia

AU - Stortecky, Stefan

AU - Nissen, Henrik

AU - Holzamer, Andreas

AU - Urena, Marina

AU - Testa, Luca

AU - Agrifoglio, Marco

AU - Whisenant, Brian

AU - Sathananthan, Janarthanan

AU - Napodano, Massimo

AU - Landi, Antonio

AU - Fiorina, Claudia

AU - Zittermann, Armin

AU - Veulemans, Verena

AU - Sinning, Jan-Malte

AU - Saia, Francesco

AU - Brecker, Stephen

AU - Presbitero, Patrizia

AU - De Backer, Ole

AU - Søndergaard, Lars

AU - Bruschi, Giuseppe

AU - Franco, Luis Nombela

AU - Petronio, Anna Sonia

AU - Barbanti, Marco

AU - Cerillo, Alfredo

AU - Spargias, Konstantinos

AU - Schofer, Joachim

AU - Cohen, Mauricio

AU - Muñoz-Garcia, Antonio

AU - Finkelstein, Ariel

AU - Adam, Matti

AU - Serra, Vicenç

AU - Teles, Rui Campante

AU - Champagnac, Didier

AU - Iadanza, Alessandro

AU - Chodor, Piotr

AU - Eggebrecht, Holger

AU - Welsh, Robert

AU - Caixeta, Adriano

AU - Salizzoni, Stefano

AU - Dager, Antonio

AU - Auffret, Vincent

AU - Cheema, Asim

AU - Ubben, Timm

AU - Ancona, Marco

AU - Rudolph, Tanja

AU - Gummert, Jan

AU - Tseng, Elaine

AU - Noble, Stephane

AU - Bunc, Matjaz

AU - Roberts, David

AU - Kass, Malek

AU - Gupta, Anuj

AU - Leon, Martin B

AU - Dvir, Danny

N1 - Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2020. For permissions, please email: journals.permissions@oup.com.

PY - 2020/8/1

Y1 - 2020/8/1

N2 - AIMS: Due to bioprosthetic valve degeneration, aortic valve-in-valve (ViV) procedures are increasingly performed. There are no data on long-term outcomes after aortic ViV. Our aim was to perform a large-scale assessment of long-term survival and reintervention after aortic ViV.METHODS AND RESULTS: A total of 1006 aortic ViV procedures performed more than 5 years ago [mean age 77.7 ± 9.7 years; 58.8% male; median STS-PROM score 7.3% (4.2-12.0)] were included in the analysis. Patients were treated with Medtronic self-expandable valves (CoreValve/Evolut, Medtronic Inc., Minneapolis, MN, USA) (n = 523, 52.0%), Edwards balloon-expandable valves (EBEV, SAPIEN/SAPIEN XT/SAPIEN 3, Edwards Lifesciences, Irvine, CA, USA) (n = 435, 43.2%), and other devices (n = 48, 4.8%). Survival was lower at 8 years in patients with small-failed bioprostheses [internal diameter (ID) ≤ 20 mm] compared with those with large-failed bioprostheses (ID > 20 mm) (33.2% vs. 40.5%, P = 0.01). Independent correlates for mortality included smaller-failed bioprosthetic valves [hazard ratio (HR) 1.07 (95% confidence interval (CI) 1.02-1.13)], age [HR 1.21 (95% CI 1.01-1.45)], and non-transfemoral access [HR 1.43 (95% CI 1.11-1.84)]. There were 40 reinterventions after ViV. Independent correlates for all-cause reintervention included pre-existing severe prosthesis-patient mismatch [subhazard ratio (SHR) 4.34 (95% CI 1.31-14.39)], device malposition [SHR 3.75 (95% CI 1.36-10.35)], EBEV [SHR 3.34 (95% CI 1.26-8.85)], and age [SHR 0.59 (95% CI 0.44-0.78)].CONCLUSIONS: The size of the original failed valve may influence long-term mortality, and the type of the transcatheter valve may influence the need for reintervention after aortic ViV.

AB - AIMS: Due to bioprosthetic valve degeneration, aortic valve-in-valve (ViV) procedures are increasingly performed. There are no data on long-term outcomes after aortic ViV. Our aim was to perform a large-scale assessment of long-term survival and reintervention after aortic ViV.METHODS AND RESULTS: A total of 1006 aortic ViV procedures performed more than 5 years ago [mean age 77.7 ± 9.7 years; 58.8% male; median STS-PROM score 7.3% (4.2-12.0)] were included in the analysis. Patients were treated with Medtronic self-expandable valves (CoreValve/Evolut, Medtronic Inc., Minneapolis, MN, USA) (n = 523, 52.0%), Edwards balloon-expandable valves (EBEV, SAPIEN/SAPIEN XT/SAPIEN 3, Edwards Lifesciences, Irvine, CA, USA) (n = 435, 43.2%), and other devices (n = 48, 4.8%). Survival was lower at 8 years in patients with small-failed bioprostheses [internal diameter (ID) ≤ 20 mm] compared with those with large-failed bioprostheses (ID > 20 mm) (33.2% vs. 40.5%, P = 0.01). Independent correlates for mortality included smaller-failed bioprosthetic valves [hazard ratio (HR) 1.07 (95% confidence interval (CI) 1.02-1.13)], age [HR 1.21 (95% CI 1.01-1.45)], and non-transfemoral access [HR 1.43 (95% CI 1.11-1.84)]. There were 40 reinterventions after ViV. Independent correlates for all-cause reintervention included pre-existing severe prosthesis-patient mismatch [subhazard ratio (SHR) 4.34 (95% CI 1.31-14.39)], device malposition [SHR 3.75 (95% CI 1.36-10.35)], EBEV [SHR 3.34 (95% CI 1.26-8.85)], and age [SHR 0.59 (95% CI 0.44-0.78)].CONCLUSIONS: The size of the original failed valve may influence long-term mortality, and the type of the transcatheter valve may influence the need for reintervention after aortic ViV.

KW - Aged

KW - Aged, 80 and over

KW - Aortic Valve/surgery

KW - Aortic Valve Stenosis/surgery

KW - Bioprosthesis

KW - Female

KW - Heart Valve Prosthesis

KW - Heart Valve Prosthesis Implantation

KW - Humans

KW - Male

KW - Prosthesis Design

KW - Prosthesis Failure

KW - Transcatheter Aortic Valve Replacement

KW - Treatment Outcome

U2 - 10.1093/eurheartj/ehaa544

DO - 10.1093/eurheartj/ehaa544

M3 - SCORING: Journal article

C2 - 32592401

VL - 41

SP - 2731

EP - 2742

JO - EUR HEART J

JF - EUR HEART J

SN - 0195-668X

IS - 29

ER -