Three-Year Outcomes of Second Bioprosthesis After Early Surgical Aortic Bioprosthetic Failure

Bioprosthetic valves are widely used in patients aged ≥65 years, but their durability is limited by structural valve deterioration (SVD). Data on repeat bioprosthetic aortic valve replacement (AVR) for early SVD (≤5 years) are scarce.

The purpose of this study was to evaluate 3-year hemodynamic outcomes and the incidence of recurrent SVD following repeat AVR.

The authors retrospectively studied patients with surgical aortic valve replacement (SAVR) and early SVD requiring reintervention at Abbott Northwestern Hospital from January 2012 to December 2022. All patients had echocardiographic follow-up ≥30 days after repeat AVR. The primary endpoint was early SVD of the second bioprosthesis as per Valve Academic Research Consortium 3 criteria within 5 years after repeat SAVR or valve-in-valve transcatheter aortic valve replacement (TAVR). Secondary outcomes were mortality, congestive heart failure admission, and acute stroke.

Among 92 patients requiring reintervention for early SVD after SAVR, 76 had TAVR upon reintervention, and 16 had repeat SAVR. Recurrent early SVD occurred in 20 patients (21.7%); 13 (65.0%) occurred in the first year. Recurrent early SVD rates were higher, but not statistically different among patients receiving TAVR-after-SAVR (23.7%) vs SAVR-after-SAVR (12.5%) (adjusted HR: 3.31; 95% CI: 0.43-25.5; P = 0.23). Mean gradient ≥20 mm Hg, aortic valve area <1.0 cm², and moderate/severe aortic regurgitation at discharge or 30 days were independent predictors of recurrent early SVD. At 3 years, mortality was 18.5%, stroke was 5.4%, and congestive heart failure was 26.1%.

Early failure of the second bioprosthesis after reintervention, especially following valve-in-valve TAVR, mostly occurred within the first year. Residual hemodynamic abnormalities at discharge strongly predict early SVD.