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Updated: Jun 3, 2026

Full-root Aortic Valve Replacement by Stentless Aortic Xenografts in Patients with Small Aortic Roots
Published on: May 21, 2017
Valve type and post-dilation impact on transprosthetic gradients in patients undergoing transcatheter aortic
Manuela Muratori1, Laura Fusini1,2, Gloria Tamborini1
1Perioperative Cardiology and Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, via Parea 4, 20138 Milan, Italy.
Aims:
Valve-in-Valve transcatheter aortic valve replacement (ViV-TAVR) is an appealing treatment option for patients with degenerated aortic bioprosthetic valves. However, higher post-procedural transprosthetic gradients are more common after ViV-TAVR than after TAVR for native aortic valve stenosis. We sought to evaluate the impact of type of implanted valve and balloon post-dilation on echocardiographic results and mortality in ViV-TAVR patients.
Methods And Results:
One hundred and eleven consecutive patients were enrolled. A balloon-expandable valve, a self-expandable valve without balloon post-dilation, and a self-expandable valve with balloon post-dilation were performed in 35 (Group 1), 39 (Group 2), and 37 (Group 3) patients, respectively. All patients underwent comprehensive transthoracic echocardiography at baseline, discharge, and 6-12 months follow-up. Successful ViV-TAVR was performed in 110 patients (99%). Baseline transprosthetic gradients, left ventricular volumes, ejection fraction, and pulmonary artery systolic pressure were similar among groups. All groups experienced a significant reduction in post-procedural gradients at discharge and during the 6-12 months follow-up compared with baseline. At discharge, the lowest mean gradient was observed in Group 3 (12 ± 7 mmHg) compared with both Group 1 (20 ± 9 mmHg) and Group 2 (17 ± 8 mmHg, P = 0.001). This result was confirmed at 6-12 months follow-up (P = 0.012). Similar 5-year all-cause mortality was observed among groups (34%, 36%, 14%, respectively, P = 0.056).
Conclusion:
In patients with failed surgical aortic prosthesis, ViV-TAVR is an effective treatment option associated with sustained improved haemodynamics regardless of transcatheter valve type and use of balloon post-dilation. However, self-expandable valves with balloon post-dilation showed lower transprosthetic gradients.
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