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Long-Term Outcomes After Transcatheter Aortic Valve-in-Valve Replacement
Leonardo de Freitas Campos Guimarães1, Marina Urena2, Harindra C Wijeysundera3
1Quebec Heart and Lung Institute, Laval University, Canada (L.d.F.C.G., J.-M.P., E.D., P.P., J.R.-C.).
Circulation. Cardiovascular Interventions
|October 26, 2018
Summary
Long-term outcomes after valve-in-valve transcatheter aortic valve replacement (ViV-TAVR) show stable hemodynamics and infrequent clinically relevant structural valve degeneration (SVD). However, about one in ten patients experienced some SVD, highlighting the need for continued monitoring.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Surgery
Background:
- Long-term data on valve-in-valve (ViV) transcatheter aortic valve replacement (TAVR) outcomes are limited.
- Assessing structural valve degeneration (SVD) is crucial for evaluating the durability of ViV-TAVR.
Purpose of the Study:
- To determine the long-term clinical outcomes following ViV-TAVR.
- To evaluate the incidence and progression of SVD in patients who underwent ViV-TAVR.
Main Methods:
- A prospective study included 116 patients undergoing ViV-TAVR across 9 centers (2009-2015).
- Patients received yearly clinical and echocardiographic follow-up.
- SVD was defined by specific criteria for subclinical and clinically relevant degeneration.
Main Results:
- At a median 3-year follow-up, 25.9% of patients had died (17.2% from cardiovascular causes).
- Mean transvalvular gradients remained stable up to 5 years (P=0.92).
- Clinically relevant SVD occurred in 3.0% of patients, while subclinical SVD was observed in 15.1%.
Conclusions:
- Approximately one-fourth of ViV-TAVR recipients died by 3-year follow-up.
- Valve hemodynamics were stable long-term, with infrequent clinically relevant SVD.
- A notable proportion of patients experienced some degree of SVD, warranting ongoing surveillance.
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