151. Transcatheter aortic valve-in-valve implantation: clinical outcome as defined by VARC-2 and postprocedural valve dysfunction according to the primary mode of bioprosthesis failure.
- Author
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Stähli BE, Reinthaler M, Nguyen-Kim TD, Gebhard C, Tasnady H, Grünenfelder J, Falk V, Corti R, Frauenfelder T, Lüscher TF, Maier W, Mullen MJ, and Landmesser U
- Subjects
- Adult, Aged, Aged, 80 and over, Feasibility Studies, Female, Hospitals, University, Humans, London, Male, Middle Aged, Reoperation mortality, Research, Switzerland, Transcatheter Aortic Valve Replacement mortality, Treatment Outcome, Bioprosthesis, Postoperative Complications etiology, Postoperative Complications surgery, Prosthesis Failure, Transcatheter Aortic Valve Replacement methods
- Abstract
Objectives: The objectives of this study were to investigate: (1) the clinical outcome of transcatheter aortic valve-in-valve (VIV) implantation according to Valve Academic Research Consortium (VARC)-2 criteria; and (2) to determine whether postprocedural transvalvular gradients differ in patients with bioprosthesis regurgitation or stenosis as primary mode of failure., Background: Transcatheter aortic VIV implantation has become a feasible option for selected high-risk patients with failed aortic surgical bioprostheses., Methods: Transcatheter aortic VIV implantation was performed in 14 high-risk individuals at the University of Zurich and University College London., Results: The prosthesis was successfully implanted in 13 patients (93%). In 1 patient, a second transcatheter valve needed to be implanted due to valve malpositioning. Thirty-day all-cause mortality was 7% (1/14). Prosthetic valve dysfunction according to VARC-2 at 30 days was observed in 7/14 patients (50%) due to an increased postprocedural transvalvular gradient >20 mm Hg. Preprocedural transaortic gradients correlated significantly with postprocedural gradients (r=0.91; P<.001). At 30-day follow-up, postprocedural gradients were higher in patients with aortic stenosis as primary mode of failure as compared to those with aortic regurgitation (36 ± 6 mm Hg vs 16 ± 4 mm Hg; P=.01). None of the patients exhibited prosthetic valve regurgitation of more than mild degree., Conclusion: The feasibility and safety of VIV implantation in failed aortic bioprostheses is demonstrated. A higher postprocedural gradient was observed after VIV implantation in patients with aortic stenosis as compared to regurgitation as primary mode of failure.
- Published
- 2014