Transcatheter valve-in-valve therapy using 6 different devices in 4 anatomic positions: Clinical outcomes and technical considerations

• Published in: The Journal of thoracic and cardiovascular surgery Vol. 150; no. 6; pp. 1557 - 1567.e3
• Main Authors: Conradi, Lenard, MD, Silaschi, Miriam, MD, Seiffert, Moritz, MD, Lubos, Edith, MD, Blankenberg, Stefan, MD, Reichenspurner, Hermann, MD, PhD, Schaefer, Ulrich, MD, Treede, Hendrik, MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.12.2015
• Subjects: Aged; Bioprosthesis - adverse effects; Cardiac Catheterization; Cardiothoracic Surgery; Female; Heart Valve Diseases - surgery; Heart Valve Prosthesis - adverse effects; Heart Valve Prosthesis Implantation - methods; Humans; Male; Prosthesis Failure; Retrospective Studies; structural valve deterioration; transcatheter; Treatment Outcome; valve-in-valve; VIVID; TTE; rapid ventricular pacing; PVL; TAVI; valve-in-valve international data; surgical aortic valve implantation; interquartile range; transcatheter; LVOT; PPM; RVP; logEuroSCORE I; patient prosthesis mismatch; paravalvular leakage; logistic European System for Cardiac Operative Risk Evaluation I; 28.1; transcatheter aortic valve implantation; Valve Academic Research Consortium 2; ViV; THV; left ventricular outflow tract; transcatheter heart valve; transthoracic echocardiography; 35.3.5; IQR; 35.4.2; SAVR; CP; 35.2; indexed effective orifice area; MSCT; STS-PROM; TEE; Society of Thoracic Surgeons Predicted Risk of Mortality; valve-in-valve; structural valve deterioration; transesophageal echocardiography; VARC-2; multislice computed tomography; Cheatham platinum; iEOA
• ISSN: 0022-5223; 1097-685X
• DOI: 10.1016/j.jtcvs.2015.08.065

Abstract Objectives Transcatheter valve-in-valve implantation (ViV) is emerging as a novel treatment option for patients with deteriorated bioprostheses. We report our cumulative experience using 6 types of transcatheter heart valves (THVs) in all anatomic positions. Methods Seventy-five consecutive patients (74.1 ± 12.9 years, 50.7% male (38/75), logEuroSCORE I 26.2% ± 17.8%, STS-PROM 8.8% ± 7.4%) receiving ViV procedures from 2008 to 2014 were included for analysis. Data were prospectively gathered and retrospectively analyzed. Results ViV was performed in aortic (72.0%, 54/75), mitral (22.7%, 17/75), tricuspid (2.7%, 2/75), and pulmonary (2.7%, 2/75) positions. THVs used were Edwards SAPIEN (XT)/SAPIEN3 (52.0%, 39/75), Medtronic Core Valve/Core Valve Evolut(R) (34.7%, 26/75), St Jude Portico (4.0%, 3/75), Boston Scientific Lotus (4.0%, 3/75), Jena Valve (2.7%, 2/75), and Medtronic Engager (2.7%, 2/75). Interval from index procedure to ViV was 9.3 ± 4.9 years. Access was transapical in 53.3% (40/75), transfemoral (transarterial or transvenous) in 42.7% (32/75), transaortic in 2.7% (2/75), and transjugular in 1.3% (1/75). ViV was successful in 97.3% (73/75) with 2 patients requiring sequential THV implantation for initial malpositioning. Overall immediate procedural (≤72 hours) and all-cause 30-day mortality were 2.7% (2/75) and 8.0% (6/75). Corresponding values after aortic ViV were 1.9% (1/54) and 5.6% (3/54). No periprocedural strokes or cases of coronary obstruction occurred. Paravalvular leakage was less than or equal to mild in all cases. After aortic ViV, gradients were max/mean 34.1 ± 14.2/20.1 ± 7.1 mm Hg and effective orifice area (EOA) was 1.5 ± 1.4 cm2 . Corresponding values after mitral ViV were gradients max/mean 14.2 ± 8.2/4.7 ± 3.1 mm Hg and EOA 2.4 ± 0.9 cm2. Conclusions ViV can be performed in all anatomic positions with acceptable hemodynamic and clinical outcome in high-risk patients. Increasing importance of ViV can be anticipated considering growing use of surgical bioprostheses.