Five-Year Follow-Up from the CoreValve Expanded Use Transcatheter Aortic Valve-in-Surgical Aortic Valve Study.

Area of Science:

• Cardiology
• Interventional Cardiology
• Cardiac Surgery

Background:

• Transcatheter aortic valve replacement (TAVR) offers an alternative for extreme-risk patients needing reoperation for a failed surgical aortic bioprosthesis.
• Long-term data for TAV-in-SAV procedures are limited, necessitating further investigation into their durability and safety.

Purpose of the Study:

• To evaluate the 5-year outcomes of TAV-in-SAV using the CoreValve Expanded Use Study.
• To analyze outcomes based on the mode of surgical aortic valve failure (stenosis, regurgitation, or combined).

Main Methods:

• The CoreValve Expanded Use Study enrolled 226 extreme-risk patients undergoing TAV-in-SAV.
• Outcomes were assessed at 5 years, stratified by surgical aortic valve failure mode.
• Echocardiographic data were reported by study sites.

Main Results:

• The 5-year all-cause mortality or major stroke rate was 47.2%.
• Mortality was higher in patients with severe prosthesis-patient mismatch (51.7% vs 38.3%).
• The overall aortic valve reintervention rate was 5.9%, with stable hemodynamic function and minimal severe paravalvular regurgitation at 5 years.

Conclusions:

• TAV-in-SAV with a supra-annular, self-expanding TAVR device is a safe and durable option for extreme-risk patients with appropriately sized failed surgical valves.
• Clinical and hemodynamic outcomes remain stable through 5 years post-procedure.