Outcomes of Valve-in-Valve Transcatheter Aortic Valve Replacement

• Published in: The American journal of cardiology Vol. 215; pp. 1 - 7
• Main Authors: Ahmad, Danial, Yousef, Sarah, Kliner, Dustin, Brown, James A., Serna-Gallegos, Derek, Toma, Catalin, Makani, Amber, West, David, Wang, Yisi, Thoma, Floyd W., Sultan, Ibrahim
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 15.03.2024; Elsevier Limited
• Subjects: Aorta; Aortic valve; Bioprosthesis - adverse effects; Cardiac arrhythmia; Coronary vessels; Degeneration; Ejection fraction; Estimates; Female; Hazards; Health hazards; Heart failure; Heart surgery; Heart valves; Humans; Morbidity; Mortality; Pacemakers; Patients; Prosthesis Design; Prosthesis Failure; Regression analysis; Regression models; Retrospective Studies; Risk; Risk groups; Survival; TAVI; TAVR; Thorax; transcatheter aortic valve replacement; Transcatheter Aortic Valve Replacement - adverse effects; Treatment Outcome; valve-in-valve; ViV-TAVR; New York; United States > US; valve-in-valve; transcatheter aortic valve replacement; ViV-TAVR; TAVR; TAVI
• ISSN: 0002-9149; 1879-1913; 1879-1913
• DOI: 10.1016/j.amjcard.2023.12.061

Structural valve degeneration is increasingly seen given the higher rates of bioprosthetic heart valve use for surgical and transcatheter aortic valve replacement (TAVR). Valve-in-valve TAVR (VIV-TAVR) is an attractive alternate for patients who are otherwise at high risk for reoperative surgery. We compared patients who underwent VIV-TAVR and native valve TAVR through a retrospective analysis of our institutional transcatheter valve therapy (TVT) database from 2013 to 2022. Patients who underwent either a native valve TAVR or VIV-TAVR were included. VIV-TAVR was defined as TAVR in patients who underwent a previous surgical aortic valve replacement. Kaplan–Meier survival analysis was used to obtain survival estimates. A Cox proportional hazards regression model was used for the multivariable analysis of mortality. A total of 3,532 patients underwent TAVR, of whom 198 (5.6%) underwent VIV-TAVR. Patients in the VIV-TAVR cohort were younger than patients who underwent native valve TAVR (79.5 vs 84 years, p <0.001), with comparable number of women and a higher Society of Thoracic Surgeons risk score (6.28 vs 4.46, p <0.001). The VIV-TAVR cohort had a higher incidence of major vascular complications (2.5% vs 0.8%, p = 0.008) but lower incidence of permanent pacemaker placement (2.5% vs 8.1%, p = 0.004). The incidence of stroke was comparable between the groups (VIV-TAVR 2.5% vs native TAVR 2.4%, p = 0.911). The 30-day readmission rates (VIV-TAVR 7.1% vs native TAVR 9%, p = 0.348), as well as in-hospital (VIV-TAVR 2% vs native TAVR 1.4%, p = 0.46), and overall (VIV-TAVR 26.3% vs native TAVR 30.8%, p = 0.18) mortality at a follow-up of 1.8 years (0.83 to 3.5) were comparable between the groups. The survival estimates were also comparable between the groups (log-rank p = 0.27). On multivariable Cox regression analysis, VIV-TAVR was associated with decreased hazards of death (hazard ratio 0.68 [0.5 to 0.9], p = 0.02). In conclusion, VIV-TAVR is a feasible and safe strategy for high-risk patients with bioprosthetic valve failure. There may be potentially higher short-term morbidity with VIV-TAVR, with no overt impact on survival.