Transcatheter Aortic Valve Implantation Within Degenerated Aortic Surgical Bioprostheses PARTNER 2 Valve-in-Valve Registry JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY Webb, J. G., Mack, M. J., White, J. M., Dvir, D., Blanke, P., Herrmann, H. C., Leipsic, J., Kodali, S. K., Makkar, R., Miller, D. C., Pibarot, P., Pichard, A., Satler, L. F., Svensson, L., Alu, M. C., Suri, R. M., Leon, M. B. 2017; 69 (18): 2253-2262

Abstract

Early experience with transcatheter aortic valve replacement (TAVR) within failed bioprosthetic surgical aortic valves has shown that valve-in-valve (VIV) TAVR is a feasible therapeutic option with acceptable acute procedural results.The authors examined 30-day and 1-year outcomes in a large cohort of high-risk patients undergoing VIV TAVR.Patients with symptomatic degeneration of surgical aortic bioprostheses at high risk (=50% major morbidity or mortality) for reoperative surgery were prospectively enrolled in the multicenter PARTNER (Placement of Aortic Transcatheter Valves) 2 VIV trial and continued access registries.Valve-in-valve procedures were performed in 365 patients (96 initial registry, 269 continued access patients). Mean age was 78.9 ± 10.2 years, and mean Society of Thoracic Surgeons score was 9.1 ± 4.7%. At 30 days, all-cause mortality was 2.7%, stroke was 2.7%, major vascular complication was 4.1%, conversion to surgery was 0.6%, coronary occlusion was 0.8%, and new pacemaker insertion was 1.9%. One-year all-cause mortality was 12.4%. Mortality fell from the initial registry to the subsequent continued access registry, both at 30 days (8.2% vs. 0.7%, respectively; p = 0.0001) and at 1 year (19.7% vs. 9.8%, respectively; p = 0.006). At 1 year, mean gradient was 17.6 mm Hg, and effective orifice area was 1.16 cm(2), with greater than mild paravalvular regurgitation of 1.9%. Left ventricular ejection fraction increased (50.6% to 54.2%), and mass index decreased (135.7 to 117.6 g/m(2)), with reductions in both mitral (34.9% vs. 12.7%) and tricuspid (31.8% vs. 21.2%) moderate or severe regurgitation (all p < 0.0001). Kansas City Cardiomyopathy Questionnaire score increased (mean: 43.1 to 77.0) and 6-min walk test distance results increased (mean: 163.6 to 252.3 m; both p < 0.0001).In high-risk patients, TAVR for bioprosthetic aortic valve failure is associated with relatively low mortality and complication rates, improved hemodynamics, and excellent functional and quality-of-life outcomes at 1 year. (The PARTNER II Trial: Placement of AoRTic TraNscathetER Valves [PARTNER II]; NCT01314313).

View details for DOI 10.1016/j.jacc.2017.02.057

View details for PubMedID 28473128