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208
Outcomes in Valve-in-Valve Transcatheter Aortic Valve Implantation
Astrid C van Nieuwkerk1, Raquel B Santos2, Eduard Fernandez-Nofrerias3
1Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam University Medical Center, University of Amsterdam, Netherlands.
The American Journal of Cardiology
|March 30, 2022
Summary
Valve-in-valve transcatheter aortic valve implantation (ViV-TAVI) shows comparable safety and effectiveness to native valve TAVI. Self-expandable valves in ViV-TAVI procedures were associated with less bleeding and numerically lower mortality.
Area of Science:
- Cardiology
- Interventional Cardiology
- Biomedical Engineering
Background:
- Transcatheter aortic valve implantation (TAVI) is a standard treatment for aortic stenosis.
- Valve-in-valve TAVI (ViV-TAVI) is increasingly used for degenerated bioprosthetic valves.
- Limited data exist on ViV-TAVI outcomes and optimal valve selection.
Purpose of the Study:
- To compare clinical outcomes of ViV-TAVI versus native valve TAVI (NV-TAVI).
- To evaluate the impact of valve type (self-expandable vs. balloon-expandable) in ViV-TAVI procedures.
Main Methods:
- Propensity score matching was used to create comparable cohorts.
- 256 ViV-TAVI patients were matched 1:2 with 512 NV-TAVI patients.
- Outcomes including mortality, stroke, and pacemaker implantation were analyzed.
Main Results:
- Mortality and stroke rates at 30 days and 1 year were similar between ViV-TAVI and NV-TAVI groups.
- Permanent pacemaker implantation was less frequent in ViV-TAVI patients (8.8% vs. 15.0%, p=0.02).
- In ViV-TAVI, self-expandable valves showed significantly less 30-day major bleeding (3% vs. 13%, p=0.01).
Conclusions:
- ViV-TAVI is a safe and effective treatment option for failing bioprosthetic valves.
- Clinical outcomes of ViV-TAVI are comparable to NV-TAVI.
- Self-expandable valves may offer an advantage in reducing bleeding complications in ViV-TAVI.
