Transcatheter aortic valve-in-valve implantation in failed stentless valves: a single-center experience

Valve-in-valve transcatheter aortic valve implantation (ViV-TAVI) offers an alternative to repeat cardiac surgery in selected patients. However, ViV-TAVI in previously implanted stentless valves is more challenging than in a stented valve. This single-center study aimed to analyze the outcomes of ViV-TAVI in stentless valves.

Data were retrospectively collected from 1476 patients undergoing TAVI between January 2018 and December 2023. The primary study endpoint was 30-day and follow-up mortality. Secondary outcomes included Valve Academic Research Consortium (VARC)-3 technical success, VARC-3 device success, and VARC-3 early safety.

A total of 15 patients underwent ViV-TAVI within previously implanted stentless valves. The mean age of the patients was 78.1 ± 9.3 years, with a median STS-PROM score of 4.30 (3.05, 6.75). The mean time between SAVR and TAVI was 14.7 ± 3.9 years. Eight (53.3%) patients presented with severe aortic regurgitation, while 5 (33.3%) patients had severe aortic stenosis. There were no surgical conversions, but a single case of transcatheter heart valve malposition required the deployment of a second valve. One patient died within 30 days. VARC-3 technical success was achieved in 87.6% (n = 13) of patients, device success in 80% (n = 12), and early safety in 73.3% (n = 11). The median follow-up period was 2.9 (range, 1.3-4.3) years, during which 4 patients died.

Careful patient selection is critical for ViV-TAVI procedures because of the high risk of complications, which is increased with stentless valves in addition to the standard risks associated with the ViV procedure. Larger studies are warranted to confirm these findings.