A comparison of valve‐in‐valve transcatheter aortic valve replacement in failed stentless versus stented surgical bioprosthetic aortic valves

• Published in: Catheterization and cardiovascular interventions Vol. 93; no. 6; pp. 1106 - 1115
• Main Authors: Choi, Charles H., Cheng, Vivian, Malaver, Diego, Kon, Neal, Kincaid, Edward H., Gandhi, Sanjay K., Applegate, Robert J., Zhao, David X. M.
• Format: Journal Article
• Language: English
• Published: Hoboken, USA John Wiley & Sons, Inc 01-05-2019; Wiley Subscription Services, Inc
• Subjects: Aged; Aged, 80 and over; Aortic stenosis; Aortic valve; Aortic Valve - diagnostic imaging; Aortic Valve - physiopathology; Aortic Valve - surgery; Aortic Valve Insufficiency - diagnostic imaging; Aortic Valve Insufficiency - mortality; Aortic Valve Insufficiency - physiopathology; Aortic Valve Insufficiency - surgery; aortic valve replacement; Aortic Valve Stenosis - diagnostic imaging; Aortic Valve Stenosis - mortality; Aortic Valve Stenosis - physiopathology; Aortic Valve Stenosis - surgery; Bioprosthesis; Complications; Electrocardiography; Female; Health care facilities; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation - adverse effects; Heart Valve Prosthesis Implantation - instrumentation; Heart Valve Prosthesis Implantation - mortality; Hemodynamics; homograft; Humans; Implantation; Male; Middle Aged; Prosthesis Design; Prosthesis Failure; Recovery of Function; Retrospective Studies; Risk Factors; Stenosis; stented; stentless; Stents; Time Factors; transcatheter aortic valve implantation; Transcatheter Aortic Valve Replacement - adverse effects; Transcatheter Aortic Valve Replacement - mortality; Treatment Outcome; Valvular and Structural Heart Diseases; transcatheter aortic valve implantation; stented; homograft; aortic valve replacement; stentless
• ISSN: 1522-1946; 1522-726X
• DOI: 10.1002/ccd.28039

Objectives
The objectives of this study were to compare short‐ and intermediate‐term clinical outcomes, procedural complications, TAVR prosthesis hemodynamics, and paravalvular leak (PVL) in stentless and stented groups.
Background
Valve‐in‐valve (ViV) transcatheter aortic valve replacement (TAVR) is an alternative to surgical redo for bioprosthetic valve failure. There have been limited data on ViV in stentless surgical valves.
Methods
We retrospectively analyzed 40 patients who underwent ViV TAVR in prior surgical bioprosthetic valves at Wake Forest Baptist Medical Center from October 2014 to September 2017. Eighty percent (32/40) ViV TAVRs were in stentless, while 20% (8/40) were in stented bioprosthetic valves.
Results
The primary mode of bioprosthetic valve failure for ViV implantation in the stentless group was aortic insufficiency (78%, 25/32), while in the stented group was aortic stenosis (75%, 6/8). The ViV procedure success was 96.9% (31/32) in stentless group and 100% in stented group (8/8). There were no significant differences in all‐cause mortality at 30 days between stentless and stented groups (6.9%, 2/31 versus 0%, 0/8, P = 0.33) and at 1 year (0%, 0/25 versus 0%, 0/5). In the stentless group, 34.4% (11/32) required a second valve compared to the stented group of 0% (0/8). There was a significant difference in the mean aortic gradient at 30‐day follow‐up (12.33 ± 6.33 mmHg and 22.63 ± 8.45 mmHg in stentless and stented groups, P < 0.05) and at 6‐month follow‐up (9.75 ± 5.07 mmHg and 24.00 ± 11.28 mmHg, P < 0.05), respectively.
Conclusions
ViV in the stentless bioprosthetic aortic valve has excellent procedural success and intermediate‐term results. Our study shows promising data that may support the application of TAVR in stentless surgical aortic valve. However, further and larger studies need to further validate our single center's experience.