Transcatheter Aortic Valve Replacement for Degenerative Bioprosthetic Surgical Valves: Results from the Global Valve-in-Valve Registry
Background—Transcatheter aortic valve-in-valve (VIV) implantation is an emerging therapeutic alternative for patients with failed surgical bioprosthesis and may obviate the need for reoperation. We evaluated the clinical results of this technique using a large, worldwide registry.
Methods and Results—The Global Valve-in-Valve Registry included 202 patients with degenerated bioprosthetic valves (age 77.7 ± 10.4 years; 52.5% men) from 38 cardiac centers. Bioprosthesis mode of failure was stenosis (n=85, 42%), regurgitation (n=68, 34%) or combined stenosis and regurgitation (n=49, 24%). Implanted devices included CoreValve (n=124) and Edwards SAPIEN (n=78). Procedural success was achieved in 93.1% of cases. Adverse procedural outcomes included initial device malposition in 15.3% of cases and ostial coronary obstruction in 3.5%. Post-procedure, valve maximum / mean gradients were 28.4 ± 14.1 mmHg / 15.9 ± 8.6 mmHg and 95% of patients had ≤ +1 degree of aortic regurgitation. At 30 days' follow-up, all-cause mortality was 8.4% and 83.7% of patients were at New York Heart Association functional class I/II. One-year follow-up was obtained in 87 patients, with 85.8% survival of treated patients.
Conclusions—The VIV procedure is clinically effective in the vast majority of patients with degenerated stenotic or regurgitant bioprosthetic valves. Safety and efficacy concerns include device malposition, ostial coronary obstruction, and high gradients after the procedure.
- Received March 12, 2012.
- Accepted July 20, 2012.
- Copyright © 2012, American Heart Association, Inc. All rights reserved. Unauthorized use prohibited