Transcatheter aortic valve-in-valve implantation in degenerative rapid deployment bioprostheses

AIMS: The aim of this study was to evaluate transcatheter aortic valve-in-valve (ViV) implantation performance in rapid deployment (ViVr) vs. conventional (ViVc) surgical heart valves.

METHODS AND RESULTS: A multicentre registry was developed as part of the VIVID international registry. A total of 30 ViVr patients (Perceval, n=24, ATS 3f Enable™, n=5, and the INTUITY, n=1) were evaluated and compared with 2,288 ViVc patients. Propensity score (PS) matching was performed to adjust further for bias. Compared with ViVc, ViVr patients presented twice as early after surgical heart valve (SHV) implantation (55.2±36.1 vs. 118.4±57.7 months, p<0.001), were more commonly female (82.8% vs. 41.3%, p<0.001), and had shorter body stature and reduced body weight (p<0.05 for both) prior to PS. Implantation was successful in all ViVr cases and, compared with ViVc, was associated with equally favourable haemodynamic outcomes (mean gradient: 14.6±8.3 vs. 16.2±8.9 mmHg, p=0.356; regurgitation ≥mild: 3.7% vs. 5.2%, p=0.793). Periprocedural complication rates were similar and low in both groups. There was no coronary obstruction event in any ViVr case; one patient (3.6%) died during one year of follow-up.

CONCLUSIONS: ViVr appears effective, safe and associated with favourable haemodynamic outcome.