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Transcatheter Valve-in-Valve Procedures for Bioprosthetic Valve Dysfunction in Patients With Rheumatic vs.
Mariana Pezzute Lopes1, Vitor Emer Egypto Rosa1, José Honório Palma1
1Heart Institute (InCor) Clinical Hospital, University of Sáo Paulo, Sáo Paulo, Brazil.
Frontiers in Cardiovascular Medicine
|August 23, 2021
Summary
Transcatheter valve-in-valve (ViV) implantation is a viable option for rheumatic heart disease patients with bioprosthetic valve dysfunction. While rheumatic patients showed higher early mortality, mid-term outcomes were comparable to non-rheumatic groups.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Surgery
Background:
- Bioprosthetic heart valves have limited durability, particularly in rheumatic heart disease (RHD) patients requiring repeat surgeries.
- Transcatheter valve-in-valve (ViV) implantation presents a potential minimally invasive alternative, but data is scarce.
Purpose of the Study:
- To compare baseline characteristics and clinical outcomes of rheumatic versus non-rheumatic patients undergoing transcatheter ViV implantation for severe bioprosthetic valve dysfunction.
Main Methods:
- Prospective, single-center study of 106 consecutive patients receiving transcatheter ViV implantation (May 2015 - September 2020).
- Rheumatic etiology was determined by clinical history and prior echocardiographic/surgical findings.
Main Results:
- Rheumatic patients (n=69) were more likely female, had higher rates of atrial fibrillation, and more prior surgeries compared to non-rheumatic patients (n=37).
- Device success rates were similar (75.4% rheumatic vs. 89.2% non-rheumatic).
- A trend towards higher 30-day mortality was observed in rheumatic patients (21.7% vs. 5.4%), but cumulative mortality at median 20.7 months follow-up was similar between groups.
Conclusions:
- Transcatheter ViV implantation is a suitable alternative to redo surgery for RHD patients with severe bioprosthetic valve dysfunction.
- Rheumatic patients experience higher early mortality but achieve good mid-term clinical outcomes after ViV procedures.
- Further research with larger cohorts and longer follow-up is needed to fully establish the role of ViV in RHD.
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