Valve-in-valve transcatheter aortic valve implantation for degenerated bioprosthetic heart valves
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Valve-in-valve transcatheter aortic valve implantation for degenerated bioprosthetic heart valves. / Eggebrecht, Holger; Schäfer, Ulrich; Treede, Hendrik; Boekstegers, Peter; Babin-Ebell, Jörg; Ferrari, Markus; Möllmann, Helge; Baumgartner, Helmut; Carrel, Thierry; Kahlert, Philipp; Lange, Philipp; Walther, Thomas; Erbel, Raimund; Mehta, Rajendra H; Thielmann, Matthias.
in: JACC-CARDIOVASC INTE, Jahrgang 4, Nr. 11, 11.2011, S. 1218-1227.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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T1 - Valve-in-valve transcatheter aortic valve implantation for degenerated bioprosthetic heart valves
AU - Eggebrecht, Holger
AU - Schäfer, Ulrich
AU - Treede, Hendrik
AU - Boekstegers, Peter
AU - Babin-Ebell, Jörg
AU - Ferrari, Markus
AU - Möllmann, Helge
AU - Baumgartner, Helmut
AU - Carrel, Thierry
AU - Kahlert, Philipp
AU - Lange, Philipp
AU - Walther, Thomas
AU - Erbel, Raimund
AU - Mehta, Rajendra H
AU - Thielmann, Matthias
N1 - Copyright © 2011 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
PY - 2011/11
Y1 - 2011/11
N2 - OBJECTIVES: We sought to analyze outcomes of patients with degenerated surgically implanted bioprosthetic heart valves undergoing valve-in-valve (viv) transcatheter aortic valve implantation (TAVI).BACKGROUND: Redo cardiac surgery for degenerated bioprosthetic heart valves is associated with increased risks, particular in elderly patients with comorbidities. For these patients, TAVI may be an attractive, less invasive treatment option.METHODS: Data from 47 patients age 64 to 97 years (logistic euroSCORE: 35.0 ± 18.5%) undergoing transfemoral (n = 25) or transapical (n = 22) viv-TAVI for failed bioprosthetic aortic valves 113 ± 65 months after initial surgery at 9 clinical sites in Germany and Switzerland were analyzed.RESULTS: Valve-in-valve TAVI was technically successful in all patients, with 2 patients requiring bailout implantation of a second TAVI prosthesis for severe regurgitation during the procedure. There was 1 procedural death as the result of low-output failure. Valvular function after viv-TAVI was excellent with respect to valve competence, but increased transvalvular gradients ≥20 mm Hg were noted in 44% of patients. Vascular access complications occurred in 6 (13%) patients, and 5 (11%) patients required new pacemaker implantation after viv-TAVI. Renal failure requiring dialysis occurred in 4 (9%) patients. Mortality at 30 days was 17% (1 procedural and 7 post-procedural deaths), with 3 of 8 fatalities the result of non-valve-related septic complications.CONCLUSIONS: Valve-in-valve TAVI can be performed with high technical success rates, acceptable post-procedural valvular function, and excellent functional improvement. However, in these predominantly elderly high-risk patients with multiple comorbidities, viv-TAVI was associated with 17% mortality, often because of septic complications arising in the post-operative phase.
AB - OBJECTIVES: We sought to analyze outcomes of patients with degenerated surgically implanted bioprosthetic heart valves undergoing valve-in-valve (viv) transcatheter aortic valve implantation (TAVI).BACKGROUND: Redo cardiac surgery for degenerated bioprosthetic heart valves is associated with increased risks, particular in elderly patients with comorbidities. For these patients, TAVI may be an attractive, less invasive treatment option.METHODS: Data from 47 patients age 64 to 97 years (logistic euroSCORE: 35.0 ± 18.5%) undergoing transfemoral (n = 25) or transapical (n = 22) viv-TAVI for failed bioprosthetic aortic valves 113 ± 65 months after initial surgery at 9 clinical sites in Germany and Switzerland were analyzed.RESULTS: Valve-in-valve TAVI was technically successful in all patients, with 2 patients requiring bailout implantation of a second TAVI prosthesis for severe regurgitation during the procedure. There was 1 procedural death as the result of low-output failure. Valvular function after viv-TAVI was excellent with respect to valve competence, but increased transvalvular gradients ≥20 mm Hg were noted in 44% of patients. Vascular access complications occurred in 6 (13%) patients, and 5 (11%) patients required new pacemaker implantation after viv-TAVI. Renal failure requiring dialysis occurred in 4 (9%) patients. Mortality at 30 days was 17% (1 procedural and 7 post-procedural deaths), with 3 of 8 fatalities the result of non-valve-related septic complications.CONCLUSIONS: Valve-in-valve TAVI can be performed with high technical success rates, acceptable post-procedural valvular function, and excellent functional improvement. However, in these predominantly elderly high-risk patients with multiple comorbidities, viv-TAVI was associated with 17% mortality, often because of septic complications arising in the post-operative phase.
KW - Aged
KW - Aged, 80 and over
KW - Analysis of Variance
KW - Aortic Valve/physiopathology
KW - Bioprosthesis
KW - Cardiac Catheterization/adverse effects
KW - Female
KW - Germany
KW - Heart Valve Diseases/mortality
KW - Heart Valve Prosthesis
KW - Heart Valve Prosthesis Implantation/adverse effects
KW - Humans
KW - Kaplan-Meier Estimate
KW - Male
KW - Middle Aged
KW - Prosthesis Design
KW - Prosthesis Failure
KW - Registries
KW - Retrospective Studies
KW - Risk Assessment
KW - Risk Factors
KW - Switzerland
KW - Treatment Outcome
U2 - 10.1016/j.jcin.2011.07.015
DO - 10.1016/j.jcin.2011.07.015
M3 - SCORING: Journal article
C2 - 22115663
VL - 4
SP - 1218
EP - 1227
JO - JACC-CARDIOVASC INTE
JF - JACC-CARDIOVASC INTE
SN - 1936-8798
IS - 11
ER -
