Predictors of Procedural Success in Patients With Degenerated Surgical Valves Undergoing Transcatheter Aortic Valve-in-Valve Implantation

Abstract

Background: Valve-in-Valve transcatheter aortic valve implantation (ViV-TAVI) is a growing alternative for redo-surgery in patients with degenerated surgical valves. To our knowledge, data are lacking on the determinants on ViV-TAVI procedural success in patients with degenerated surgical valves.Methods: All consecutive patients undergoing ViV-TAVI for degenerated surgical valves at the Cleveland Clinic were analyzed. Data were extracted from our patient registry on baseline patient characteristics, echocardiographic parameters, and procedural details. To identify possible predictors of ViV-TAVI procedural success, we employed a multivariate logistic regression model.Results: A total of 186 patients who underwent ViV-TAVI were analyzed, with procedural success (VARC-2 device success and absence of periprocedural MACCE) reported in 165 (88.7%) patients. Patients with successful ViV-TAVI were significantly younger and had more frequent utilization of the transfemoral access than those with failed procedure. Other baseline and procedural characteristics were comparable between both groups. In terms of echocardiographic parameters, the procedural success group had a significantly lower AV peak pressure gradient (62.1 ± 24.7 vs. 74.1 ± 34.6 mmHg; p = 0.04) and lower incidence of moderate-to-severe aortic regurgitation [AR] (30.4 vs. 55%; p = 0.04). However, no significant differences between both groups were noted in terms of AV mean pressure gradient and left ventricular measurements. In multivariate analysis, lower AV peak pressure gradient (OR = 0.97, 95% CI: 0.95–0.99) and absence of moderate-to-severe AR (OR = 0.65, 95% CI: 0.44–0.95) at baseline emerged as independent predictors of ViV-TAVI procedural success.Conclusion: Valve-in-Valve TAVI for degenerated surgical valves is a feasible approach with high success rates, especially in those with lower AV peak pressure gradient and absence of moderate-to-severe AR. Studies with larger sample size and longer follow-up are required to further characterize the predictors of ViV-TAVI success and other clinical outcomes.

Short- and Medium-Term Outcomes Comparison of Native- and Valve-in-Valve TAVI Procedures

“…In-hospital and 1-year mortality rates following ViV-TAVI were 8.8% and 11.8%, comparable to those observed in the NV-TAVI group. In our patients, there were no major strokes or TIAs observed immediately or during the hospital stay, and our device success rate was comparable between ViV and NV-TAVI groups (88.23% vs. 91.17%), findings also in agreement with the literature [ 1 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 ].…”

Redo aortic valve replacement vs valve-in-valve trans-catheter aortic valve implantation: a UK propensity-matched analysis

“…Similarly, in a recent study 3.7% of patients treated with the same intervention reported moderate AR at one-year [22]. Finally, a study from Cleveland showed the presence of moderate-severe aortic regurgitation in 30.4% of patients undergoing ViV-TAVI [23].…”