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Long-term outcomes after transcatheter aortic valve implantation in failed bioprosthetic valves

2020; Oxford University Press; Volume: 41; Issue: 29 Linguagem: Inglês

10.1093/eurheartj/ehaa544

1522-9645

Sabine Bleiziffer, Matheus Simonato, John G. Webb, Josep Rodés‐Cabau, Philippe Pîbarot, Ran Kornowski, Stephan Windecker, Magdalena Erlebach, Alison Duncan, Moritz Seiffert, Axel Unbehaun, Christian Frerker, Lars O. Conzelmann, Harindra C. Wijeysundera, Won‐Keun Kim, Matteo Montorfano, Azeem Latib, Didier Tchetchè, Abdelhakim Allali, Mohamed Abdel‐Wahab, Katia Orvin, Stefan Stortecky, Henrik Nissen, Andreas Holzamer, Marina Ureña, Luca Testa, Marco Agrifoglio, Brian Whisenant, Janarthanan Sathananthan, Massimo Napodano, Antonio Landi, Claudia Fiorina, Armin Zittermann, Verena Veulemans, Jan-Malte Sinning, Francesco Saia, Stephen Brecker, Patrizia Presbitero, Ole De Backer, Lars Søndergaard, Giuseppe Bruschi, Luis Nombela‐Franco, Anna Sonia Petronio, Marco Barbanti, Alfredo Giuseppe Cerillo, Konstantinos Spargias, Joachim Schöfer, Mauricio G. Cohen, Antonio J. Muñoz-García, Ariel Finkelstein, Matti Adam, Violeta Serra, Rui Campante Teles, Didier Champagnac, Alessandro Iadanza, Piotr Chodór, Holger Eggebrecht, Robert C. Welsh, Adriano Caixeta, Stefano Salizzoni, Antonio Dager, Vincent Auffret, Asim N. Cheema, Timm Ubben, Marco Ancona, Tanja K. Rudolph, Jan Gummert, Elaine E. Tseng, Stéphane Noble, Matjaž Bunc, David E. Roberts, Malek Kass, Anuj Gupta, Martin B. Leon, Danny Dvir,

Infective Endocarditis Diagnosis and Management

Due to bioprosthetic valve degeneration, aortic valve-in-valve (ViV) procedures are increasingly performed. There are no data on long-term outcomes after aortic ViV. Our aim was to perform a large-scale assessment of long-term survival and reintervention after aortic ViV.A total of 1006 aortic ViV procedures performed more than 5 years ago [mean age 77.7 ± 9.7 years; 58.8% male; median STS-PROM score 7.3% (4.2-12.0)] were included in the analysis. Patients were treated with Medtronic self-expandable valves (CoreValve/Evolut, Medtronic Inc., Minneapolis, MN, USA) (n = 523, 52.0%), Edwards balloon-expandable valves (EBEV, SAPIEN/SAPIEN XT/SAPIEN 3, Edwards Lifesciences, Irvine, CA, USA) (n = 435, 43.2%), and other devices (n = 48, 4.8%). Survival was lower at 8 years in patients with small-failed bioprostheses [internal diameter (ID) ≤ 20 mm] compared with those with large-failed bioprostheses (ID > 20 mm) (33.2% vs. 40.5%, P = 0.01). Independent correlates for mortality included smaller-failed bioprosthetic valves [hazard ratio (HR) 1.07 (95% confidence interval (CI) 1.02-1.13)], age [HR 1.21 (95% CI 1.01-1.45)], and non-transfemoral access [HR 1.43 (95% CI 1.11-1.84)]. There were 40 reinterventions after ViV. Independent correlates for all-cause reintervention included pre-existing severe prosthesis-patient mismatch [subhazard ratio (SHR) 4.34 (95% CI 1.31-14.39)], device malposition [SHR 3.75 (95% CI 1.36-10.35)], EBEV [SHR 3.34 (95% CI 1.26-8.85)], and age [SHR 0.59 (95% CI 0.44-0.78)].The size of the original failed valve may influence long-term mortality, and the type of the transcatheter valve may influence the need for reintervention after aortic ViV.